Introduction: The purpose of this study was to estimate direct medical costs associated with thrombocytopenia (TP) in adult intensive care unit (ICU) patients. Methods: All medical or surgical patients ≥18 years of age admitted to the ICU for > 48 hours with platelet count (PC) ≥ 100 × 10 3/mm3 on admission between 12/96 and 7/99 were screened. Patients receiving chemotherapy or any myelosuppressive drug in the previous 6 months were excluded. Patients were considered thrombocytopenic if their PC decreased to < 100 × 103/mm3 on 2 consecutive daily ICU laboratory measurements. Significant TP was defined as PC < 50 × 103/mm3. Clinical and resource utilization data were collected by medical chart review until hospital discharge or death. Resource units were multiplied by institution-specific costs to calculate cost. Results: Forty patients who developed TP (15 male; 25 female); mean ±SD age: 60.7 ± 16.3 years; APACHE II score: 20.5 ± 6.2; were identified for study analysis. Mean duration of TP was 5.4 ± 2.6 days; mean minimum PC was 56.8 ± 23.0 ×103/mm3. Seventeen patients (42.5%) experienced significant TP, 15 of whom died during their hospital stay compared to 6 of 23 nonsignificant TP patients (p < 0.001). The mean ± SD number of blood units administered to TP patients included: PRBC 2.2 ± 3.9; FFP 2.9 ± 8.4; and platelets 3.6 ± 11.8. The average direct medical cost per patient was $2,650. The largest cost categories were transfusions (81.6%), medications (8.0%) and related procedures (6.8%). 70.5% of total direct costs were consumed by 8 patients who developed TP-related complications (6 GIB, 1 alveolar hemorrhage, 1 extensive DVT). Total mean direct medical cost for patients developing significant TP was $5,064 (range $0-14.9K), compared to $939 (range $0-6.8K) in those patients whose PC did not decrease below 50 × 103/mm3 (p = 0.41). Costs > $7,500 were associated with significant TP (4/17 vs. 0/23; p = 0.026). Conclusion: These results demonstrate the cost of TP may be considerable, with the majority of costs related to complications. Further, development of significant TP is associated with higher direct medical costs in an adult ICU population.
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine