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2022, Number 1

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Rev Hematol Mex 2022; 23 (1)

Economic evaluation of the use of thrombopoietin receptor agonists in adult patients with primary immune thrombocytopenia in Mexico

Carlos-Rivera F, Guzmán-Caniupan JA, Alva-Esqueda M, Aubry MT, Camacho-Cordero LM

Language: Spanish
References: 24
Page: 17-27
PDF size: 298.23 Kb.


ABSTRACT

Objective: To compare, by an analytic decision-making model, both the costs and effectiveness of romiplostim, eltrombopag and watch and rescue (W&R) in adult patients with primary immune thrombocytopenia in Mexico.
Materials and Methods: A comparative analysis of costs and health outcomes among two or more mutually exclusive interventions. We combined a decision tree with a 24-weeks Markov process, examining the proportion of patients with overall platelet response depending on the history of splenectomy and the received intervention. Those patients without overall platelet response entailed a higher risk of bleeding-related episodes. We evaluated the acquisition costs of the study agents plus the costs of management of patients (consultations, laboratory tests), the costs due to bleeding-related episodes (urgency/specialty visit or inpatient care, with potential use of rescue therapies) and the treatment of serious adverse events. The clinical information was gathered from literature, while the economic parameters correspond, in general, to the Mexican Institute of Social Security.
Results: Total costs were lower with W&R ($177,545 Mexican pesos), followed by romiplostim ($260,768) and eltrombopag ($271,738). The proportion of patients with overall platelet response was by far much higher with romiplostim (84.7% vs 46.3% with eltrombopag and 11.2% with W&R). The average cost per patient reaching overall platelet response was lower (better) with romiplostim. Taking W&R as a reference, the cost per additional patient with overall platelet response was lower (better) with romiplostim than eltrombopag ($113,274 vs $268,245). The sensitivity analyses showed the results are robust.
Conclusions: Romiplostim is cost-effective compared to W&R and dominant (less costly and more effective) against eltrombopag.


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