In 2017, as an internal medicine resident, I found myself taking care of a hospitalized patient with immune thrombotic thrombocytopenic purpura (TTP), a rare relapsing and remitting autoimmune-mediated hematological disease that did not have US Food and Drug Administration (FDA)–approved therapeutic options at the time. For more than a decade, leading academic medical centers across the globe had used the anti-CD20 monoclonal antibody rituximab off-label to help decrease the time-variant probability of relapse. However, my request for rituximab to treat immune TTP was denied, and the reason was cost—each dose was more than $7000. What this financial decision failed to account for is that even one repeat hospitalization is far more expensive, and this patient would surely return to our hospital for care in the case of relapse. Continue reading his award-winning essay
