Rachel Allen1, Peter Bryden2, Kelly M Grotzinger3, Ceilidh Stapelkamp4, Bethan Woods5. 1. GlaxoSmithKline, Stockley Park West, Uxbridge, Middlesex, UK. 2. University of Bristol, Bristol, UK. 3. GlaxoSmithKline, Collegeville, PA, USA. Electronic address: kmgrotzinger@embarqmail.com. 4. Novartis, London, UK. 5. Centre for Health Economics, University of York, York, UK.
Abstract
OBJECTIVES: 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.
OBJECTIVES: 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: Cindy Neunert; Deirdra R Terrell; Donald M Arnold; George Buchanan; Douglas B Cines; Nichola Cooper; Adam Cuker; Jenny M Despotovic; James N George; Rachael F Grace; Thomas Kühne; David J Kuter; Wendy Lim; Keith R McCrae; Barbara Pruitt; Hayley Shimanek; Sara K Vesely Journal: Blood Adv Date: 2019-12-10
Authors: Manraj N Kaur; Donald M Arnold; Nancy M Heddle; Richard J Cook; Cyrus Hsia; Mark Blostein; Erin Jamula; Michelle Sholzberg; Yulia Lin; Jeannine Kassis; Loree Larratt; Alan Tinmouth; Julie Carruthers; Na Li; Yang Liu; Feng Xie Journal: Blood Adv Date: 2022-02-08