A recent analysis suggested that for patients with immune thrombocytopenia (ITP), treatment with eltrombopag has potential to be cost effective compared with treatment using intravenous immunoglobulin (IVIG). The results of this study were reported in the journal Blood Advances.
The noninferiority of eltrombopag compared with IVIG in treatment of ITP in adults was demonstrated in the randomized, open-label Bridging ITP trial (ClinicalTrials.gov Identifier: NCT01621204) of patients who were treated in the context of undergoing surgery. In this cost-effectiveness study, the researchers used data from the intention-to-treat analysis of the Bridging ITP trial to evaluate treatment outcomes and resource utilization patterns from the perspective of a Canadian public health care payer.
The cost-effectiveness analysis included patients receiving perioperative eltrombopag with a 50 mg/day starting dose or with IVIG dosed at 1 or 2 g/kg. Eltrombopag was given from 21 days before surgery to 7 days postoperatively. IVIG was given 7 days before surgery, with an additional administration 7 days postoperatively if required. The observation period spanned preoperative day 21 through postoperative day 28. Costs were adjusted to 2020 Canadian dollars (CAD$) and were estimated based on information from the Ontario Schedule of Benefits, the Ontario Drug Benefit Formulary, and other sources.
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Data from 74 patients were included, with 38 patients randomly assigned to eltrombopag and 36 randomly assigned to IVIG. The treatment success rates were 79% for the eltrombopag group and 61% with IVIG.
When considering all medication costs, the use of eltrombopag cost CAD$1101 less per patient than IVIG did. When also including other medical costs, such as blood transfusions and hospital or emergency department utilization, the researchers estimated that perioperative eltrombopag was associated with a cost-saving of CAD$413 per patient with ITP. The mean +SD for the total cost of treatment was CAD$7743 + $4897 per patient in the eltrombopag group, and it was CAD$8156 + $4255 per patient in the IVIG group.
In the context of a lack of willingness to pay, eltrombopag was considered to have a 70% probability of being cost effective against IVIG. If the willingness-to-pay threshold was increased to CAD$10,000, then eltrombopag had an 88.9% probability of being cost-effective over IVIG.
A sensitivity analysis took into account variations in IVIG dosage. In this analysis, it was found that the use of eltrombopag was linked to a cost-saving of CAD$2714 per patient when IVIG was dosed at 2 g/kg. When IVIG was dosed at 1 g/kg, eltrombopag use incurred a CAD$562 greater per-patient cost. “However, due to the small sample size, this finding is hypothesis-generating and should be explored in future studies,” they wrote in their report.
“Our study demonstrates that eltrombopag was less costly than IVIG from a public health care payer’s perspective in Canada,” the researchers concluded in their report.
Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Reference
Kaur MN, Arnold DM, Heddle NM, et al. Cost-effectiveness of eltrombopag vs intravenous immunoglobulin for the perioperative management of immune thrombocytopenia. Blood Adv. 2022;6(3):785-792. doi:10.1182/bloodadvances.2021005627
