Cost estimate of platelet transfusion in the United States for patients with chronic liver disease and associated thrombocytopenia undergoing elective procedures

Barnett, Christine; Mladsi, Deirdre; Vredenburg, Michael; Aggarwal, Kamal

doi:10.1080/13696998.2018.1490301

Cited by 25 publications

(46 citation statements)

References 38 publications

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“…The results of the one-way sensitivity analysis suggest that further research into the full cost of platelet transfusion could affect the findings from this analysis. Although Barnett et al (2018) 7 detailed the cost of a platelet transfusion in the US, there is a lack of information crucial to understanding the full cost of a platelet transfusion, as the authors noted data gaps in the literature. Since not all costs could be accounted for in the cost estimate from that study, the platelet transfusion cost used here may be an underestimate.…”

Section: Discussionmentioning

confidence: 99%

“… 6 The increased risk of bleeding complications is often managed with preoperative platelet transfusion; 6 however, this treatment often does not adequately address the therapeutic need and is associated with substantial risk of allergic reactions, reduced efficacy over time, costs, and potential adverse effects. 7 Given the limitations with current standard of care, there is a need for a safe and cost-effective alternative treatment for thrombocytopenia in patients with CLD who are preparing for a procedure.…”

Section: Introductionmentioning

confidence: 99%

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<p>Cost- Effectiveness of Avatrombopag for the Treatment of Thrombocytopenia in Patients with Chronic Liver Disease</p>

Mladsi¹,

Barnett²,

Aggarwal³

et al. 2020

CEOR

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Background and Aim Thrombocytopenia is common in people with chronic liver disease, who frequently undergo invasive procedures. To minimize the risk of bleeding, prophylactic platelet transfusions have traditionally been used but carry many risks. The aim of this study was to evaluate the cost-effectiveness of avatrombopag compared with platelet transfusion and lusutrombopag as a treatment for thrombocytopenia in adult patients with chronic liver disease scheduled to undergo a medical procedure. Methods A decision-tree model was developed from a US payer perspective to capture acute events observed in phase 3 global randomized controlled clinical trials and, to support exploratory analyses, potential longer-term complications resulting from a major bleed or thromboembolic event. Treatment costs were taken from publicly available data sources. The interventions were evaluated in the overall trial populations and in subpopulations with higher and lower baseline platelet counts. Results were presented as incremental cost per platelet transfusion avoided. One-way and probabilistic sensitivity analyses were conducted. Results In the overall population, avatrombopag reduced the need for platelet transfusions and produced cost-savings compared with platelet transfusion (80% fewer prophylactic platelet transfusions, $4250 lower costs) and lusutrombopag (42% fewer prophylactic platelet transfusions, $5819 lower costs). Similar results were seen in both the higher and lower platelet count subpopulations. The one-way and probabilistic sensitivity analyses found that the use of avatrombopag is cost-saving with the incremental cost-effectiveness ratio in quadrant IV (decreased costs, prophylactic platelet transfusions avoided). Conclusion The use of avatrombopag is expected to be cost-saving while reducing the need for prophylactic platelet transfusions compared with platelet transfusion and lusutrombopag.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

<p>Cost- Effectiveness of Avatrombopag for the Treatment of Thrombocytopenia in Patients with Chronic Liver Disease</p>

Mladsi¹,

Barnett²,

Aggarwal³

et al. 2020

CEOR

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“…A study of the total cost (which includes the cost of generating supply of platelets, cost of adverse events and refractoriness to platelet transfusions) of administration of platelet transfusions among patients with CLD estimated that platelet transfusions can cost between $5258 to $13 117. 24 A study on the increased resource utilisation and costs associated with management of thrombocytopaenia in this population found that CLD patients with thrombocytopaenia incurred $43 562 in annual medical costs, compared to $12 271 among CLD patients without thrombocytopaenia. 25 A similar study on the increased resource utilisation and costs associated with management of thrombocytopaenia among patients with hepatitis C viral (HCV) indicated that HCV patients with thrombocytopaenia incur an estimated $37 924 in annual healthcare costs, compared to $12 174 among HCV patients who do not have thrombocytopaenia.…”

Section: Introductionmentioning

confidence: 94%

“…Prior studies have reported the economic burden associated with thrombocytopaenia and platelet transfusions among patients with CLD. A study of the total cost (which includes the cost of generating supply of platelets, cost of adverse events and refractoriness to platelet transfusions) of administration of platelet transfusions among patients with CLD estimated that platelet transfusions can cost between $5258 to $13 117 . A study on the increased resource utilisation and costs associated with management of thrombocytopaenia in this population found that CLD patients with thrombocytopaenia incurred $43 562 in annual medical costs, compared to $12 271 among CLD patients without thrombocytopaenia .…”

Section: Introductionmentioning

confidence: 99%

The clinical and economic burden of patients with chronic liver disease and thrombocytopaenia receiving platelet transfusions during planned invasive procedures

et al. 2019

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Summary Background Platelet transfusions (PT) are the standard of care for thrombocytopaenia in patients with chronic liver disease (CLD) who are at risk for bleeding when undergoing planned invasive procedures (PIP). In addition to PTs having short‐term effectiveness, PTs are associated with complications (transfusion‐associated circulatory overload [TACO], transfusion‐related acute lung injury [TRALI] and increased healthcare resource utilisation [HCRU]). Objective To characterise the clinical and economic burden among CLD patients who receive a PT for their PIP. Methods A retrospective analysis was performed using MarketScan® research databases. A PT‐related population that consisted of patients who received a PT for their PIP and a non‐PT‐related population diagnosed with thrombocytopaenia that did not receive a PT for their PIP were derived. Each PT‐related patient was matched with 1‐3 non‐PT‐related patients on factors predictive of severity of liver disease and increased HCRU. Results After applying the inclusion criteria and patient‐matching, 210 patients were included in the PT‐related population and 564 patients were included in the non‐PT‐related population. PT‐related patients had an increase (mean increase: $11.1K; median increase: $2.1K) in payments received between admission date of the PIP‐related hospitalisation and 30 days after discharge. PT‐related patients also had a higher proportion of bleeding events (PT‐related: 32%; non‐PT‐related: 18%), TACO‐related complications (PT‐related: 23%; non‐PT‐related: 18%) and TRALI‐related complications (PT‐related: 19%; non‐PT‐related: 14%). Conclusion PT‐related patients incurred substantially higher costs during and after their PIP‐related hospitalisation. Optimal management of thrombocytopaenia in the CLD population is critical in maintaining successful clinical and economic outcomes.

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“…Across publications reporting PT costs in CLD patients, the reported estimated cost for 1-2 PTs ranged from $500 [138] to $1639 [69], while the total estimated costs of PT were reported as $5258-13,117 in 1 publication and $4800-11,000 in another [134,138].…”

Section: Economic Burdenmentioning

confidence: 99%

A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia

Newland

Bentley

Jakubowska³

et al. 2019

Hematology

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Objective: Investigate globally, current treatment patterns, benefit-risk assessments, humanistic, societal and economic burden of platelet transfusion (PT). Methods: Publications from 1998 to June 27, 2018 were identified, based on databases searches including MEDLINE®; Embase and Cochrane Database of Systematic Reviews. Data from studies meeting pre-specified criteria were extracted and validated by independent reviewers. Data were obtained for efficacy and safety from randomized controlled trials (RCTs); data for epidemiology, treatment patterns, effectiveness, safety, humanistic and societal burden from real-world evidence (RWE) studies; and economic data from both. Results: A total of 3425 abstracts, 194 publications (190 studies) were included. PT use varied widely, from 0%-100% of TCP patients; 1.7%-24.5% in large studies (>1000 patients). Most were used prophylactically rather than therapeutically. 5 of 43 RCTs compared prophylactic PT with no intervention, with mixed results. In RWE studies PT generally increased platelet count (PC). This increase varied by patient characteristics and hence did not always translate into a clinically significant reduction in bleeding risk. Safety concerns included infection risk, alloimmunization and refractoriness with associated cost burden. Discussion: In RCTs and RWE studies there was significant heterogeneity in study design and outcome measures. In RWE studies, patients receiving PT may have been at higher risk than those not receiving PT creating potential bias. There were limited data on humanistic and societal burden. Conclusion: Although PTs are used widely for increasing PC in TCP, it is important to understand the limitations of PTs, and to explore the use of alternative treatment options where available.

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Cost estimate of platelet transfusion in the United States for patients with chronic liver disease and associated thrombocytopenia undergoing elective procedures

Cited by 25 publications

References 38 publications

<p>Cost- Effectiveness of Avatrombopag for the Treatment of Thrombocytopenia in Patients with Chronic Liver Disease</p>

<p>Cost- Effectiveness of Avatrombopag for the Treatment of Thrombocytopenia in Patients with Chronic Liver Disease</p>

The clinical and economic burden of patients with chronic liver disease and thrombocytopaenia receiving platelet transfusions during planned invasive procedures

A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia

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