PDG23 Budget IMPACT Analysis of Eltrombopag Olamina for Immune Thrombocytopenia (ITP) in the Brazilian Private Healthcare System (BPHS)

Abstract

Immune thrombocytopenia (ITP) patients who have major bleeding complications require urgent platelet count increase with immunoglobulin rescue therapy (IRT), which is a procedure related to high cost impact for healthcare systems. Therefore, this study aimed to estimate the budget impact of including eltrombopag olamine for ITP patients who had insufficient response to corticosteroids, immunoglobulins or splenectomy in the Brazilian Private Healthcare System (BPHS). A budget impact model was developed to estimate total cost of including eltrombopag olamine in BPHS. To determine the eligible patient population, an epidemiological approach was adopted, considering total of adult beneficiaries in BPHS, ITP prevalence of 16.5/100,000 inhabitants, patients who need treatment (50%) and ITP patients who are refractory to first-line treatment (85%). Watch and rescue (WR) was the comparator. Estimated per year usage of IRT was estimated in 4.5 (Weitz, 2012). Reduction of IRT usage in consequence of eltrombopag administration was obtained from Elgebaly, 2016. A five-year time horizon was considered. Cost of treatment considered direct medical costs obtained from the Brazilian official price list - considering factory price (18% VAT) and calculated according to the average eltrombopag dosage published in RAISE study. Average costs related to IRT were obtained from an analysis of the Brazilian private market database published by Kim, 2019. Market share of eltrombopag was estimated in 40% in the first year after incorporation and 80% in the fifth year. WR resulted in a cost of BRL281,338 per patient/year, on the other hand, treatment with eltrombopag cost BRL243,628. Cost of treatment per patient/year showed the use of eltrombopag resulted in savings of BRL37,710. In ITP total population eligible to treatment, eltrombopag inclusion promoted an accumulated economic saving of BRL272,2 million in five years. Eltrombopag would lead to savings to BPHS generated by reduction in need of IRT in comparison to WR scenario.