The Comparative Pharmacoeconomic Analysis of Using Different Agonists of The Thrombopoietin Receptor In Adult Patients With Chronic Idiopathic Thrombocytopenic Purpura In Actual Practice In Russia

Abstract

To perform cost-effectiveness analysis of using different thrombopoietin (TPO) receptor agonists - romiplostim and eltrombopag - in adult patients with chronic idiopathic thrombocytopenic purpura (ITP) taking into account compliance in the management of them in actual practice in Russia. MS Excel based model of medical care patients with chronic ITP has been developed based on the research hypothesis that the level of patient compliance in certain categories can affect the effectiveness of long-term therapy with different TPO receptor agonists – romiplostim 250 mcg SC once weekly and eltrombpag 50 mg per os once daily. To evaluate the real clinical practice of patients with chronic ITP in Russia interview of experts was conducted. Direct medical costs including drugs, injections, therapy monitoring (CBC, platelet count), rescue treatment, bleeding treatment (grade 3, 4 with the WHO bleeding scale), outpatient visits were calculated for 1 patient for 1 year. The overall platelet response was included into the model as the effectiveness criteria. A survey of experts showed that the using of romiplostim is associated with a higher compliance in patients with a chronic ITP, therefore with a higher efficacy of treatment. The total costs of treatment per patient with chronic ITP within 1 year were $67,468 with romiplostim and $30,975 with eltrombopag. However, taking into account a possible low level of compliance of patients in certain categories in real clinical practice in Russia the cost-effectiveness ratio for romiplostim amounted to $81,287/1 case effectively treatment compared with $110,625/1 case of effective treatment for eltrombopag. The difference amounted to $29,338 in favor of the romiplostim (rate for June 2017). Using of romiplostim in the treatment of adult patients with chronic ITP was effective and economically justified treatment option in real clinical practice in Russia in patients with low compliance.