Financial Health Spotlight: The Cost of Managing ITP

Immune thrombocytopenia (ITP) is a rare condition that causes a low platelet count. People with ITP can experience life threatening bleeding if the condition is not treated.

Many people with ITP go into remission within the first 6 months . Up to two-thirds of those who don’t experience remission have a stable platelet count with first-line treatments, such as corticosteroids and intravenous (IV) immunoglobulin therapy.

Others may see their ITP come back and require second-line treatments, such as medications like rituximab or thrombopoietin receptor agonists, or removal of the spleen.

People with ITP may have repeat hospitalizations for bleeding, doctor’s visits for blood count testing, and other medical services in addition to direct ITP treatment.

Treatments for ITP can be costly if paid out of pocket. However, private insurance and government programs, such as Medicare, may cover some costs. Drug manufacturers may also provide low cost or no cost options for people who can’t afford the medications.

Here’s an overview of the primary treatments for ITP and how much they may cost out of pocket.

Given the high cost of medical care, it’s hardly a shock that patients are drowning in medical debt. Almost 20% of American households have delinquent medical bills that affect their credit report, according to NBC News. Having medical bills in collections makes it more difficult for patients to engage in other economic activities, such as purchasing a home or securing a loan to start a business.

Corticosteroids are often the first-line treatment for ITP. They work by stopping the body from destroying platelets.

The American Society of Hematology (ASH) 2019 guidelines for ITP treatment recommend staying on steroids for no longer than 6 weeks because of side effects. Additionally, 6 weeks is typically enough time to tell whether someone will experience remission or need more treatment.

Prednisone and dexamethasone are the most common corticosteroids used for ITP. They’re typically taken by mouth. Dexamethasone may also be administered via IV.

Corticosteroids are considered a low cost option to treat ITP. Prices vary by pharmacy, dose, and means of administration (IV or tablet). If administered by IV, costs may be higher.

Intravenous immunoglobulin (IVIg) is a blood product enriched with antibodies. It’s given by infusion. You typically need only one dose of IVIg.

IVIg increases platelet counts. It’s also a first-line therapy for ITP that may be used with or instead of corticosteroids.

According to 2019 research, insurance companies paid an average of $4,154 per IVIg infusion in 2016 and Medicare paid an average of $3,282.

Rituximab is a monoclonal antibody drug. It works by ridding the body of B-cells. B-cells are the main source of antibodies that cause the loss of platelets in people with ITP.

ASH guidelines recommend rituximab as a second-line therapy after corticosteroids in most cases.

Rituximab is typically administered by IV. The drug is given once per week for 4 consecutive weeks.

A 2020 study estimated that a two-infusion protocol of rituximab cost about $19,452 in 2018. More than 90% of those costs were for the medication itself but also included medical personnel and other costs.

Thrombopoietin receptor agonists (TPO-RA) are also a second-line therapy for ITP. They include the medications eltrombopag and romiplostim.

TPO-RAs work by increasing the number of megakaryocytes, which are cells that make platelets. These medications are taken as an oral suspension, given as an injection, or taken in tablet form.

According to a 2018 study, 24 weeks (6 months) of treatment with eltrombopag costs about $36,949 and romiplostim costs approximately $43,762 to $44,321.

When doctor’s visits, tests, and bleeding-related episodes are included, costs can be $48,043 to $52,616 for 24 weeks for eltrombopag and $51,828 to $54,509 for romiplostim.

A splenectomy is the surgical removal of the spleen. In people with ITP, the spleen is where the body gets rid of platelets. It also plays a critical role in the development of antibodies that destroy platelets.

Splenectomy is the last treatment option. It’s typically recommended only when other treatments have not worked.

Costs of spleen removal surgery may vary by the treatment center. A 2020 report by CBS News states that a total splenectomy can cost on average $47,860.

Private insurance, Medicare, or Medicaid may cover all or part of the cost of ITP treatments. The Platelet Disorder Support Association (PDSA) recommends reading the details of your insurance to determine what they will cover and how much is covered.

Coverage may depend on:

• the location of the treatment (hospital or home)
• method of administration (IV or pill taken by mouth)
• whether the treatment is approved by the Food and Drug Administration (FDA) for ITP

If your insurance claim for an ITP treatment is turned down, you can ask the company to review your claim.

You can reduce or manage costs in several potential ways:

• Manufacturers of certain ITP drugs may offer financial assistance to those who can’t afford the medication. For example, Genentech, the company that makes Rituxan (a brand of rituximab), offers free medication for those without insurance through its Genentech Patient Foundation.
• You can browse patient programs by drug name at the website RxAssist.org.
• Your state or local government may also provide assistance. For example, the state of California has an Office of the Patient Advocate where people can find out about their rights as members of health plans and discover resources to help.
• The PDSA may also help guide you to the right support resources. The organization runs a helpline for people with ITP. You can contact the PDSA helpline at 440-746-9003 or by emailing [email protected]. They also host an online discussion group where you can connect with others also experiencing ITP.

First-line and second-line therapies for ITP can come with significant costs. Insurance does cover many of these expenses.

Some drug manufacturers may have programs to help people without insurance access medication. Patient advocacy groups, such as the PDSA, offer support and information to people living with ITP and their families.

Last medically reviewed on March 20, 2023