Abstract
Splenectomy, thrombopoietin receptor agonists and rituximabare the second-line treatments for steroid-resistant adult primaryimmune thrombocytopenia. The last two are becoming the most widelyused treatments to avoid splenectomy adverse effects and inconveniences.However, the choice between rituximab and thrombopoietin receptoragonists is unclear. Therefore, the treatment cost may be of particular interestto prioritize the therapy option. Our aim is to determine the cost perresponding-patient after 6 months of use of rituximab compared to thrombopoietinreceptor agonists eltrombopag in the treatment of chronic primaryimmune thrombocytopenia in the Spanish National Health Service. A 26-week decision tree model was developed to assess thecost of treatment response of adult patients with chronic-refractory primaryimmune thrombocytopenia to eltrombopag and rituximab from theperspective of the Spanish National Health System. Effectiveness wasobtained 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. The average cost per patient after 6 months of treatmentwas slightly higher for eltrombopag (€13,089.40) than for rituximab(€11,852.60). However, the greater response rate of eltrombopag decreasesthe bleeding costs, resulting in a 29% higher cost per responding-patientwith rituximab (€18,964.15) than for eltrombopag (€14,732.65). This resultis consistent with the results of the 15 sensitivity analyses carried out whereeltrombopag always represents a lower cost per responding patient, exceptin the sensitivity analysis in which treatment with eltrombopag is performedat its maximum dose (75mg). Only in this case, the cost per responder ofeltrombopag is €48 more expensive than that of rituximab. Likewise, thegreatest difference in favor of eltrombopag occurs in the scenario that usesthe minimum dose of this drug -25mg- (eltrombopag €7,622.14 comparedto €18,964.15 for rituximab). Thus, the cost per responding patient islower in eltrombopag even if a second cycle of retreatment with rituximabis not performed (€14,732.65 versus €15,298.61). The treatment cost of rituximab, including monitoring andbleeding costs, is higher than eltrombopag, favoring the latter over rituximabtreatment.
Published Version
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