title: The burden of immune thrombocytopenia in adults: evaluation of the thrombopoietin receptor agonist romiplostim.
abstract: BACKGROUND
  Immune thrombocytopenia (ITP) is a chronic, immune-mediated disease characterized by a transient or long-lasting decrease in platelet counts. ITP is associated with numerous serious clinical consequences. Discussed here are clinical aspects of ITP, the humanistic and economic burden of ITP, and current treatment options with a focus on romiplostim, a thrombopoietin (TPO) receptor agonist. The aim of this review is to provide decision-makers with the background information necessary to evaluate the value of romiplostim.
  
  
  METHODS
  PubMed was searched for relevant, English-language papers published from January 2006 through November 2011 relating to the epidemiology and treatment options of chronic ITP, and, focusing on the TPO mimetic romiplostim, patient-reported outcomes (PRO) and economic burden. Recent select conference abstracts were also reviewed.
  
  
  RESULTS
  The initial clinical management of ITP (e.g., corticosteroids, immunoglobulins) is often associated with adverse events and recommended for short-term use only. Splenectomy, a potentially curative second-line treatment, is associated with increased risks of bleeding and infection, and patients often require additional long-term drug intervention. ITP and its sequelae are associated with a substantial burden on patients' health-related quality-of-life (HRQoL) and increased medical costs. Use of TPO receptor agonists in ITP patients may represent a more efficient use of healthcare resources than existing therapies.
  
  
  CONCLUSIONS
  While this literature review is not a systematic review, e.g., it considers only approved therapies and published literature written in English, it provides a comprehensive overview of the clinical, humanistic, and economic factors that should be considered in treating ITP, particularly with new agents such as romiplostim. Among the limited number of safe and effective therapies currently available for chronic ITP, highly effective and well-tolerated medications such as romiplostim may reduce the healthcare resource utilization associated with ITP while improving patients' HRQoL.
authors.affiliation: Global Health Economics, Amgen Inc., Thousand Oaks, CA 91320, USA. rdeuson@amgen.com
authors.forename: Robert
authors.initials: R
authors.lastname: Deuson
authors.forename: Mark
authors.initials: M
authors.lastname: Danese
authors.forename: Susan D
authors.initials: SD
authors.lastname: Mathias
authors.forename: Marieke
authors.initials: M
authors.lastname: Schoonen
authors.forename: Jon
authors.initials: J
authors.lastname: Fryzek
mesh_terms: D000328:Adult; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D011961:Receptors, Fc / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000819:agonists*; D011993:Recombinant Fusion Proteins / Q000191:economics / Q000627:therapeutic use*; D013926:Thrombopoietin / Q000191:economics / Q000627:therapeutic use*
chemical_list: D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim