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Original Research: THROMBOSIS |

The Financial Impact of Heparin-Induced Thrombocytopenia

Maureen A. Smythe, PharmD, FCCP; John M. Koerber, PharmD; Maureen Fitzgerald, MBA; Joan C. Mattson, MD
Author and Funding Information

*From the Departments of Pharmaceutical Services (Drs. Smythe and Koerber), Financial Services (Ms. Fitzgerald), and Clinical Pathology (Dr. Mattson), William Beaumont Hospital, Royal Oak, MI.

Correspondence to: Maureen A. Smythe, PharmD, FCCP, Department of Pharmacy Practice, Suite 2190, Wayne State University, 259 Mack Ave, Detroit, MI 48202; e-mail: msmythe@beaumont.edu


All authors meet the criteria for authorship. Dr. Smythe and Dr. Koerber had full access to all the study data, and take responsibility for the integrity of the data and the accuracy of the data analysis.

Preliminary data were presented at the 47th Annual Meeting of the American Society of Hematology, Atlanta, GA, December 10–13, 2005.

Dr. Smythe has served as a speaker for GlaxoSmithKline. Dr. Koerber, Ms. Fitzgerald, and Dr. Mattson, have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(3):568-573. doi:10.1378/chest.08-0120
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Background:  Heparin-induced thrombocytopenia (HIT) is an adverse drug reaction that increases patient morbidity and mortality. The financial impact of HIT to an institution is thought to be significant. The objective of this study was to evaluate the financial impact of HIT.

Methods:  A case-control study was employed. Case patients were identified as newly diagnosed HIT patients. Control subjects were matched by diagnosis-related group, primary diagnosis code, primary procedure code, and hospital admission date. The financial/decision support database of the hospital was queried to identify the matched control subjects, total cost, and reimbursement. The determination of financial impact included the total profit or (total loss) and the backfill effect (ie, the lost operating margin resulting from increased length of stay). Length of stay and mortality were compared.

Results:  Data from 22 case patients and 255 control subjects were analyzed. On average, HIT case patients incurred a financial loss of $14,387 per patient and an increase in length of stay of 14.5 days. When confining the analysis to only Medicare case patients (n = 17) and Medicare control subjects, case patients incurred a financial loss of $20,170 per case and an increase in length of stay of 15.8 days. Depending on the occupancy rate of the institution, additional financial loss could result from the backfill effect. Mortality was not significantly affected.

Conclusion:  For an institution that sees 50 new cases of HIT per year, the projected annual financial impact ranges from approximately $700,000 to $1 million. Institutions with high bed occupancy rates may see an additional loss from the backfill effect.


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