Cost-per-responder analysis comparing romiplostim to rituximab in the treatment of adult primary immune thrombocytopenia in Spain

Rehman

Internal Medicine Journal

et al. 2015

Section: Discussionsupporting

confidence: 56%

Section: Surgery Daymentioning

confidence: 99%

Use of romiplostim in patients with chronic idiopathic thrombocytopenic purpura during perioperative period

Rehman

Internal Medicine Journal

et al. 2015

“…This was followed by a period of 18 weeks in which a) only patients responding to eltrombopag continued to be treated and b) patients on rituximab were treated according to previously described bases [26]. This structure is coherent with the previously mentioned study carried out in Spain [27], so it may support decision-making.…”

Section: Modelmentioning

confidence: 67%

“…We have developed a cost-consequence model to compare the direct health costs of ITP treatment with eltrombopag and rixutimab from the perspective of Spanish public hospitals. As in a similar study comparing romiplostim and rituximab [27], only direct hospital health costs of patients treated with eltrombopag and rituximab were considered. Grade 1 (petechial) bleedings, which are treated by the patients themselves or at the primary care services, were not considered.…”

Section: Modelmentioning

confidence: 99%

See 1 more Smart Citation

Per-head cost of patients responding to eltrombopag and rituximab in the treatment of primary immune thrombocytopenia in Spain.

González‐Porras

Parrondo-García²,

Anguita

2020

Preprint

Background: Splenectomy, thrombopoietin receptor agonists (TPO-RAs) and rituximab are the secondline treatments for steroid-resistant adult primary immune thrombocytopenia (ITP). The last two are becoming the most widely used treatments to avoid splenectomy adverse effects and inconveniences.However, the choice between rituximab and TPO-RAs is unclear. Therefore, the treatment cost may be of particular interest to prioritize the therapy option.Our aim is to determine the cost per patient after 6 months of treatment of rituximab compared to TPO-RA eltrombopag in a European Health Service.Methods: A 26-week decision tree model was developed to assess the cost of treatment response of adult patients with chronic-refractory ITP to eltrombopag and rixutimab from the perspective of the Spanish National Health System. Effectiveness was obtained from the literature, and cost was obtained from the official rates. Costs were expressed in € (2018). Due to the short period of assessment, no discount rate was applied.Results: The average cost per patient after 6 months of treatment was similar for eltrombopag and rituximab, although the first cost was slightly higher. However, the greater response rate of eltrombopag decreases the bleeding costs, resulting in a 29% higher cost with rituximab treatment.Eltrombopag cost was always lower, except in the sensitivity analysis in which the patient received a daily dose of 75 mg of eltrombopag, a scenario where eltrombopag cost is 48€ higher than that of rituximab.Conclusions: The treatment cost of rituximab, including monitoring and bleeding costs, is higher than eltrombopag, favouring the latter over rituximab treatment. BackgroundPrimary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by a platelet count less than 100 x 10 9 platelets/litre; this is due to platelet destruction and inadequate production [1,2]. Diagnosis is reached by exclusion of other diseases associated with thrombocytopenia. The annual ITP incidence rate is 3-4/100000 in adults, increasing in older patients [3][4][5]. This condition is classified as newly diagnosed ITP when the evolution is shorter than 3 months 3 from diagnosis, persistent if the duration of disease is 3-12 months and chronic when it lasts for more than 12 months [1]. Although 1/3 of affected persons are asymptomatic and patients with a platelet count over 50 x 10 9 platelets/litre do not require treatment, this long-lasting disease may threaten life due to bleeding caused by thrombocytopenia; it negatively impacts quality of life and imparts a high economic burden on the healthcare system [1,2,6].Classical guidelines recommended corticosteroids as first-line treatment for adult ITP followed by splenectomy as second-line treatment and the use of the anti-CD20 chimeric monoclonal antibody rituximab or a thrombopoietin receptor agonist (TPO-RA) in cases of failure or contraindication [2,7,8].Splenectomy achieves a 60% response after 5 years [9]. However, this treatment produces important adverse effects mainly derive...

Per-head cost of patients responding to eltrombopag and rituximab in the treatment of primary immune thrombocytopenia in Spain.

González‐Porras

Parrondo-García²,

Anguita

2019

Preprint

Background: Splenectomy, thrombopoietin receptor agonists (TPO-RAs) and rituximab are the second line treatments for steroid resistant adult primary immune thrombocytopenia (ITP). The last two are becoming the most widely used to avoid splenectomy adverse effects and inconveniences. However, the choice between rituximab and TPO-RAs is unclear. Therefore, the treatment cost may be of particular interest to prioritize the therapy option. Our aim is to know the cost per patient after a 6 months treatment in a European Health Service of rituximab compared to the TPO-RA eltrombopag. Methods: A 26-weeks decision tree model have been developed to assess the cost of treatment response of adult patients with chronic-refractory ITP to eltrombopag and rixutimab under the perspective of the Spanish National Health system. Effectiveness were obtained from literature and cost from the official rates. Costs were expressed in €(2018). Due to the short period of assessment, no discount rate was applied. Results: Average cost per patient after a 6 months treatment was similar for eltrombopag and rituximab, although the first one was slightly higher. However, the greater response rate of eltrombopag decreases the bleeding costs, resulting in a 29% higher cost with rituximab treatment. Eltrombopag cost is always lesser, except in the sensitivity analysis in which the patient received a daily dose of 75 mg of eltrombopag –a scenario where eltrombopag cost is 48€ higher than that of rituximab. Conclusions: The treatment cost of rituximab, including monitoring and bleeding costs is higher than eltrombopag, favouring the last one over rituximab treatment.