Reported by Liu Chia-Yun from Taipei

For years, the NHI-reimbursed oral drugs that boost platelet production for the treatment of immune thrombocytopenic purpura (ITP) have only been available for adult patients.  The NHIA recently revised the reimbursement regulations to include children over 6-year-old into the reimbursement scope. About 20 children every year will benefit from this new reimbursement regulation.  Though the number is just a few, it will be a big help to their families as the treatments cost about NT$400,000 – NT$500,000 a year.

According to the NHIA’s data, the incidence rate of ITP is about 1-12 cases per 100,000 persons.  The total ITP patient population in Taiwan is estimated to be about 2000.

ITP is a clinical syndrome in which a decreased number of circulating platelets manifests as a bleeding tendency, easy bruising (purpura), or extravasation of blood from capillaries into skin and mucous membrane.  Patients might have minor conditions, such as skin bruises, or succumb to life-threatening conditions, such as brain hemorrhage. 

Dr Lu Meng-Yao of the NTUH pointed out that the cause of the ITP is still not clear.  It is suspected to be associated with virus infection or immune deficiency.   Patients often have skin bruises due to low level of platelets.

About 70-80% of ITP cases are acute attack; and patients can usually heal themselves in months.  Only very few children develop into a chronic condition and need medical treatments. The first line-treatments include steroid, immunoglobulin, etc.

Lien Zhou-Jei of the NHIA pointed out that the oral drugs that boost platelet production have been available under the NHI since 2011.  They have only been available for adults with chronic ITP for whom the treatments of steroid, immunoglobulin or spleen removal have failed.

Now, the NHIA decided to extend the reimbursement to children as the drugs have been proved to be safe and effective for children. 

A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.  For patients with ITP, their immune system considers platelets to be foreign substances, hence, triggers an attack and prevents the platelet production. ITP patient’s platelet count is lower than 50,000 platelets per microliter of blood.  They are suffering from bleeding, internal bleeding and bruises.  In severe cases, patients may have intracerebral hemorrhage and pulmonary bleeding which could be life threatening.

【019-05-20/ United Daily News】