title: [Economic evaluation of Thrombopoietin Receptor Agonists in the treatment of chronic primary immune thrombocytopenia].
abstract: OBJECTIVE
  To develop a tool to assist the decision-making for selection of Thrombopoyetin Receptor Agonists of adult patients with chronic immune primary thrombocytopenia (PTI).
  
  
  METHODS
  Stochastic cost-effectiveness analysis with a 6-Health- States Markov model: stable, bleeding type 2, 3 or 4, post-type 4 bleeding and death. Each simulation analyzes a randomly generated scenario that describes patients characteristics, results measured in quality adjusted life years (QALYs) and costs (in ?2011). Distributions were obtained from the Spanish data of the European health survey of 2009, the INE estimate of population for 2011 and the 6-months clinical studies for Eltrombopag and Romiplostim. Utility values were obtained from the literature and the costs from Spanish official rates lists. A set of 10.000 random scenarios were generated and the patients evolution of each scenario was simulated during a time horizon of five years (in 2-weeks cycles). National Health System Perspective was used and the annual discount rate was set at 3%.
  
  
  RESULTS
  Eltrombopag showed more effectiveness in 9.983 scenarios and there was no difference in 17. In 7.048 scenarios the alternative Eltombopag was dominant. It was cost-effective in another 19 (threshold 30,000 ??/AVAC).
  
  
  CONCLUSIONS
  Eltrombopag was the most cost-effective alternative in 70,67% of the simulated scenarios and its use could produce lower costs to the NHS.
authors.forename: J
authors.initials: J
authors.lastname: Parrondo
authors.forename: C
authors.initials: C
authors.lastname: Grande
authors.forename: J
authors.initials: J
authors.lastname: Ibáñez
authors.forename: J
authors.initials: J
authors.lastname: Palau
authors.forename: J A
authors.initials: JA
authors.lastname: Páramo
authors.forename: G
authors.initials: G
authors.lastname: Villa
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001565:Benzoates / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003198:Computer Simulation; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006470:Hemorrhage / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006834:Hydrazines / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D011720:Pyrazoles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D011961:Receptors, Fc / Q000627:therapeutic use; D053628:Receptors, Thrombopoietin / Q000819:agonists*; D011993:Recombinant Fusion Proteins / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D012720:Severity of Illness Index; D013030:Spain; D013156:Splenectomy; D013269:Stochastic Processes; D013926:Thrombopoietin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D001565:Benzoates; D006834:Hydrazines; D011720:Pyrazoles; D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; C082218:MPL protein, human; D013926:Thrombopoietin; C488777:romiplostim; C520809:eltrombopag