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

Brown, Robert S.; Bentley, Roy; Cai, Bin; Flamm, Steven L.; Kanakamedala, Hemanth; Lai, Jennifer C.; Marcella, Stephen; Muir, Andrew J.; Brown, Kimberly

doi:10.1002/ygh2.357

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…Studies have shown that platelet counts below 50 to 75 × 10 9 /L can be associated with a higher risk of bleeding in patients undergoing a range of invasive procedures, requiring platelet transfusions or other rescue therapies for bleeding, posing a substantial healthcare burden in these patients [ 8 , 10 , 51 – 54 ]. Recently, a pooled post hoc analysis of the lusutrombopag phase 2b, L-PLUS 1, and L-PLUS 2 studies found that patients treated with lusutrombopag without platelet transfusion demonstrated a trend toward fewer procedural and post-procedural bleeding events compared to patients receiving platelet transfusions plus placebo treatment [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

“…Reducing the need for pre-procedural platelet transfusions and rescue treatment for up to 7 days post procedure in patients with severe thrombocytopenia may have a significant positive impact on their healthcare resource utilization. As an oral treatment, given once a day for 7 days, lusutrombopag is simple to administer, and can be easily scheduled in advance of a planned procedure, a significant contrast to the resources an inpatient pre-procedural platelet transfusion would require, especially in a post-pandemic environment [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

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Systematic Review with Meta-Analysis: Efficacy and Safety of Lusutrombopag for Severe Thrombocytopenia in Patients with Chronic Liver Disease Undergoing Invasive Procedures

Orme¹,

Bentley

Marcella

et al. 2022

Adv Ther

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Introduction: Lusutrombopag is an oral thrombopoietin receptor agonist (TPO-RA). Clinical trials have shown lusutrombopag's efficacy in reducing need for preoperative platelet transfusion in patients with chronic liver disease (CLD) and severe thrombocytopenia. This analysis assessed efficacy and safety of lusutrombopag in patients with severe throm-bocytopenia and CLD undergoing planned invasive procedures. Methods: An electronic database search (through 1 December 2020) identified three randomised, placebo-controlled, double-blind clinical trials comparing lusutrombopag with placebo in patients with CLD and platelet count below 50 9 10 9 /L scheduled to undergo a procedure with a perioperative bleeding risk. A random-effects meta-analysis examined treatment effect, with Cochrane Collaboration's tool assessing risk of bias.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic Review with Meta-Analysis: Efficacy and Safety of Lusutrombopag for Severe Thrombocytopenia in Patients with Chronic Liver Disease Undergoing Invasive Procedures

Orme¹,

Bentley

Marcella

et al. 2022

Adv Ther

Self Cite

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“…21,22 A recent retrospective study of claims data found a mean payment increase of $11,100 (25%) in total costs for patients with CLD and thrombocytopenia who received platelet transfusions during a planned invasive procedure-related hospital admission and matched patients who did not receive transfusion. 23 The increased cost of platelet transfusions was attributed to increased resource utilization and lengths of hospital stay driven by a significant increase in bleeding events and acute respiratory failure. A 2013 AABB survey 24 reported 54 hospitals (10.5% of those surveyed) delayed elective surgeries due to unmet platelet needs, demonstrating that reliance on platelet transfusion can cause the postponement of procedures.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Avatrombopag for the Treatment of Thrombocytopenia in Patients with Chronic Liver Disease

Allen¹,

Aggarwal²,

Vredenburg³

et al. 2019

Blood

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Background: Patients with chronic liver disease (CLD) often have severe thrombocytopenia (platelet counts <50,000/mL) that can complicate the invasive diagnostic and therapeutic procedures these patients require as part of their clinical management, due to the increased bleeding risk. Avatrombopag is a thrombopoietin receptor agonist (TPO-RA) that is approved for the treatment of thrombocytopenia in patients with CLD as an alternative to platelet transfusions for patients undergoing a procedure. The aim of this study was to evaluate the relative cost-effectiveness of avatrombopag compared with platelet transfusion or treatment with lusutrombopag, another TPO-RA also approved for the treatment of thrombocytopenia in adult patients with CLD. Methods: A decision-tree model was developed from a US payer perspective to capture the clinical events observed in registration trials, and to project potential longer-term complications resulting from a major bleed or thromboembolic event in the scenario analyses. Treatment costs were taken from publicly available data sources; avatrombopag and lusutrombopag estimates were calculated from the US prescribing information and Phase 3 study data. The interventions were evaluated in the overall trial population, patients with platelet counts <50,000/mL, and in subpopulations with higher (>40,000/mL to <50,000/mL) and lower (<40,000/mL) Baseline platelet counts. The primary metric for this economic analysis was the per-person total cost, the cost of prophylactic platelet transfusions required, and the incremental cost per prophylactic platelet transfusion avoided. Results: In the overall population, avatrombopag reduced the need for platelet transfusions and produced cost-savings per person compared to Intended Platelet Transfusion (80% fewer prophylactic platelet transfusions), resulting in a relative cost savings of $4,250. The cost for lusutrombopag (15% more platelet transfusions) relative to avatrombopag was $5,819 higher than the cost of avatrombopag. Similar results were seen in both the higher and lower platelet count subgroups. The one-way and probabilistic sensitivity analyses showed that the use of avatrombopag remained cost-saving over a wide range of changes in input variables, with the incremental cost-effectiveness ratio falling into quadrant IV (decreased costs while prophylactic platelet transfusions were avoided). Conclusions: From the cost-effectiveness standpoint, the use of avatrombopag is a practical strategy compared with the cost of both platelet transfusion and lusutrombopag, as it saves costs and reduces the need for prophylactic platelet transfusions. Table Disclosures Allen: Dova Pharmaceuticals: Equity Ownership, Other: Chief Medical Officer . Aggarwal:Dova Pharmaceuticals: Employment. Vredenburg:Dova Pharmaceuticals: Employment, Other: Shareholder.

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“…In addition, the safety measure and proper use of the platelet preparations are complicated owing to their short lifetime and the difficulty in storage management in medical facilities [ 4 ]. Furthermore, the effects of PT on increasing platelet counts [ 5 ] and reducing bleeding events [ 6 ] remain uncertain.…”

Section: Introductionmentioning

confidence: 99%

Effects of Lusutrombopag on Post-invasive Procedural Bleeding in Thrombocytopenic Patients with Chronic Liver Disease

et al. 2021

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Introduction Thrombocytopenia can increase the bleeding risk in patients with chronic liver disease (CLD) undergoing invasive procedures. Prophylactic platelet transfusion (PT) is often performed to increase platelet counts in patients with CLD undergoing invasive procedures to prevent bleeding. Lusutrombopag, a small-molecule thrombopoietin receptor agonist, is expected to be an alternative therapy to prophylactic PT. This study aimed to compare the effects between lusutrombopag and PT. Methods Data were obtained from a Japanese administrative database (April 2008–May 2019). Patients aged ≥ 18 years who underwent planned invasive procedures after the first CLD diagnosis and were observed for ≥ 30 days prior to invasive procedures were considered eligible. Patients who underwent planned invasive procedures with lusutrombopag prescription at 5–30 days before the procedure were categorized as the lusutrombopag group, whereas those who received PT at 1 day before and/or on the same day as the procedure, without lusutrombopag prescription, were classified as the PT group. Outcomes, including bleeding frequency during hospitalization and average medical costs (costs for prophylactic treatment and total costs between the day of the invasive procedure and 30 days after the invasive procedure), were compared between the groups after matching. Results Among 738,878 patients with CLD, 379 cases for each group were identified after matching. The incidence of bleeding events was lower in the lusutrombopag group than in the PT group (3.7% vs. 8.2%, p < 0.001). Average medical costs were lower in the lusutrombopag group than in the PT group ($6667 as of August 2021 vs. $7170, p = 0.011). Conclusion Lusutrombopag is suggested to be effective as a prophylactic treatment for bleeding prevention in patients with CLD undergoing planned invasive procedures. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01965-7.

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

Cited by 5 publications

References 26 publications

Systematic Review with Meta-Analysis: Efficacy and Safety of Lusutrombopag for Severe Thrombocytopenia in Patients with Chronic Liver Disease Undergoing Invasive Procedures

Systematic Review with Meta-Analysis: Efficacy and Safety of Lusutrombopag for Severe Thrombocytopenia in Patients with Chronic Liver Disease Undergoing Invasive Procedures

Cost-Effectiveness of Avatrombopag for the Treatment of Thrombocytopenia in Patients with Chronic Liver Disease

Effects of Lusutrombopag on Post-invasive Procedural Bleeding in Thrombocytopenic Patients with Chronic Liver Disease

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