Impact of a Treatment Protocol for Hospitalized Adults With Acute Immune Thrombocytopenia

Definitive management of acute immune thrombocytopenia (ITP) in hospitalized patients remains variable. A lack of standardized treatment protocols has led to varying treatment sequences and inconsistent utilization of resources. A viable remedy exists in developing a standardized sequential treatment protocol balancing therapeutic efficacy with financial responsibility.

The purpose of this study was to evaluate the pharmacoeconomic impact and clinical efficacy of an inpatient pharmacist-developed sequential ITP treatment protocol. The primary objective was to evaluate drug cost of ITP treatment per patient pre- versus post-protocol implementation. Secondary objectives included hospital length of stay and platelet count at discharge.

This multicenter, retrospective, quasi-experimental, institutional review board-approved study assessed hospitalized patients treated for acute ITP between October 2018 and June 2023 at Sarasota Memorial Health Care System. The ITP protocol was implemented on June 1, 2022. Retrospective chart review was performed on adult patients diagnosed with ITP who received one or more medications to treat ITP. Patients less than 18 years old, pregnant, or with sustained platelet counts greater than 100 x 10³/µL throughout admission were excluded. Propensity score matching was used to estimate the protocol effect on primary and secondary outcomes.

Of the 450 patients screened, 168 met inclusion criteria, with 115 patients assigned to the pre-protocol arm and 53 patients assigned post-protocol. In the pre-protocol cohort, 53 propensity-matched pairs were evaluated. The median drug cost of treatment was significantly higher in the pre- protocol arm compared with post-protocol ($24 899 vs $13 833; P < 0.001). There was no difference in either secondary outcome of median length of hospital stay (5.5 vs 5.2 days; P = 0.987) or median platelet count at discharge (82 vs 72; P = 0.477).

Implementation of a standardized sequential ITP treatment protocol at a community hospital resulted in substantial cost savings while maintaining positive clinical outcomes.