title: Comparative net cost impact of the utilization of romiplostim and intravenous immunoglobulin for the treatment of patients with immune thrombocytopenia in Québec, Canada.
abstract: OBJECTIVE
  Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by platelet destruction, sub-optimal platelet production, and mild-to-severe bleeding. Nplate® (romiplostim), a thrombopoietin receptor agonist, and intravenous immunoglobulin (IVIg), an expensive and occasionally scarce blood product, are used in the treatment of ITP. The objective of this study was to compare the total cost of treating patients with romiplostim vs IVIg in Québec, Canada.
  
  
  METHODS
  A net cost impact model was developed to calculate the annual cost of romiplostim compared with IVIg based on actual practice observations in all patients (n = 95) treated for chronic ITP with IVIg from April 2010 to March 2011 in two participating hospitals. The model included costs of: drug acquisition, drug preparation and administration, patient monitoring, and indirect costs. Healthcare practitioners were consulted regarding romiplostim and IVIg treatment algorithms and the resources involved in patient monitoring.
  
  
  RESULTS
  The average annual drug acquisition costs of romiplostim and IVIg were $48,024 and $98,868, respectively. Lower costs for drug preparation and administration ($309 vs $1245) and less time lost from work ($256 vs $2086) were attributed to romiplostim. The cost of follow-up monitoring was the same for both romiplostim and IVIg ($121). The total average annual per patient costs for romiplostim vs IVIg were, respectively, $48,710 and $102,320. The use of romiplostim was projected to save, on average, almost $54,000 per patient per year.
  
  
  CONCLUSIONS
  The study was conducted in two hospitals in Québec. Romiplostim may show different cost savings in other hospitals and other provincial and national jurisdictions.
  
  
  CONCLUSIONS
  Scarce blood products must be used wisely. Romiplostim can allow for improved healthcare resource allocation by reserving IVIg for use in other areas of greater need while also providing cost savings for the overall provincial healthcare budget.
authors.affiliation: Symbiose Strategic Partnership Inc., 3915 rue Saint-Urbain, Montréal, QC, Canada. mpettigrew@symbiosemkg.com
authors.forename: Martine
authors.initials: M
authors.lastname: Pettigrew
authors.forename: Kirsten
authors.initials: K
authors.lastname: Garces
authors.forename: Robert
authors.initials: R
authors.lastname: Deuson
authors.forename: Jeannine
authors.initials: J
authors.lastname: Kassis
authors.forename: Vincent
authors.initials: V
authors.lastname: Laroche
mesh_terms: D001792:Blood Platelets / Q000187:drug effects; D003362:Cost-Benefit Analysis; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000191:economics*; D017063:Outcome Assessment, Health Care / Q000191:economics; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D011792:Quebec; D011961:Receptors, Fc / Q000008:administration & dosage; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000191:economics*; D013926:Thrombopoietin / Q000008:administration & dosage / Q000191:economics*
chemical_list: D016756:Immunoglobulins, Intravenous; D011961:Receptors, Fc; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim