title: Cost-Effectiveness of Eltrombopag versus Romiplostim for the Treatment of Chronic Immune Thrombocytopenia in England and Wales.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of eltrombopag compared with romiplostim to be used in the treatment of chronic immune thrombocytopenia in patients in England and Wales who are splenectomized or ineligible for splenectomy and are refractory to other treatments.
  
  
  METHODS
  A Markov cohort model in which patients were administered a sequence of treatments was used to predict long-term outcomes associated with each treatment. The model was informed by data from the eltrombopag clinical trial program and the available literature. The analysis was conducted from the perspective of the UK National Health Service, and a lifetime time horizon was used. Deterministic and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Eltrombopag dominated romiplostim (i.e., eltrombopag was as effective as but less costly than romiplostim) in both splenectomized and nonsplenectomized patients, assuming a class effect for the two treatments. Eltrombopag also dominated romiplostim in most deterministic sensitivity analyses with the exception of when indirect efficacy estimates were incorporated into the model. In this analysis, eltrombopag no longer dominated romiplostim but remained cost-effective versus romiplostim at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year. Probabilistic sensitivity analysis demonstrated that there was a 99% and 92% chance of eltrombopag being cost-effective at a cost-effectiveness threshold of £20,000 per quality-adjusted life-year in splenectomized and nonsplenectomized patients, respectively.
  
  
  CONCLUSIONS
  Results of this study demonstrate that eltrombopag is cost-effective when compared with romiplostim to be used in the treatment of chronic immune thrombocytopenia, representing good value for the UK National Health Service.
authors: GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex, UK.
authors: Rachel
authors: R
authors: Allen
authors: University of Bristol, Bristol, UK.
authors: Peter
authors: P
authors: Bryden
authors: GlaxoSmithKline, Collegeville, PA, USA. Electronic address: kmgrotzinger@embarqmail.com.
authors: Kelly M
authors: KM
authors: Grotzinger
authors: Novartis, London, UK.
authors: Ceilidh
authors: C
authors: Stapelkamp
authors: Centre for Health Economics, University of York, York, UK.
authors: Bethan
authors: B
authors: Woods
mesh_terms: D001565:Benzoates / Q000191:economics* / Q000627:therapeutic use*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D004739:England; D006801:Humans; D006834:Hydrazines / Q000191:economics* / Q000627:therapeutic use*; D008390:Markov Chains; D011720:Pyrazoles / Q000191:economics* / Q000627:therapeutic use*; D011961:Receptors, Fc / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000191:economics* / Q000627:therapeutic use*; D013222:State Medicine; D013921:Thrombocytopenia / Q000188:drug therapy*; D013926:Thrombopoietin / Q000191:economics* / Q000627:therapeutic use*; D014852:Wales
chemical_list: D001565:Benzoates; D006834:Hydrazines; D011720:Pyrazoles; D011961:Receptors, Fc; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim; C520809:eltrombopag
keywords: chronic immune thrombocytopenia; cost-effectiveness; eltrombopag; indirect treatment comparison; romiplostim; thrombopoietin receptor agonist