A decision framework for treating chronic immune thrombocytopenia with thrombopoietin receptor agonists

J Comp Eff Res. 2018 Aug;7(8):775-784. doi: 10.2217/cer-2018-0034. Epub 2018 May 31.


Aim: Eltrombopag and romiplostim are comparable second-line therapies in chronic immune thrombocytopenia. Treatment decisions are made in different contexts. A framework was created to outline decision pathways for physicians and payers. Materials & methods: The costs of drugs, administration, routine care, bleeding, other adverse events and mortality were included in the year-long calculation of total costs from a US private payer perspective. Treatment parameters and outcome data were obtained from relevant clinical trials. Results: The total cost per year, per patient of eltrombopag was US$51,000 versus US$76,000 for romiplostim. Drug costs and costs associated with bleeding-related events were the main drivers of cost difference. Conclusion: This framework facilitates decision-making in the management of chronic immune thrombocytopenia with eltrombopag and romiplostim.

Keywords: costs; eltrombopag; immune thrombocytopenia; romiplostim; thrombopoietin receptor agonist.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Benzoates / adverse effects
  • Benzoates / economics
  • Benzoates / therapeutic use*
  • Chronic Disease
  • Clinical Decision-Making
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Decision Support Techniques*
  • Drug Costs
  • Hemorrhage / chemically induced
  • Humans
  • Hydrazines / adverse effects
  • Hydrazines / economics
  • Hydrazines / therapeutic use*
  • Purpura, Thrombocytopenic, Idiopathic / drug therapy*
  • Pyrazoles / adverse effects
  • Pyrazoles / economics
  • Pyrazoles / therapeutic use*
  • Receptors, Fc / therapeutic use*
  • Receptors, Thrombopoietin / agonists*
  • Recombinant Fusion Proteins / adverse effects
  • Recombinant Fusion Proteins / economics
  • Recombinant Fusion Proteins / therapeutic use*
  • Thrombopoietin / adverse effects
  • Thrombopoietin / economics
  • Thrombopoietin / therapeutic use*
  • United States


  • Benzoates
  • Hydrazines
  • Pyrazoles
  • Receptors, Fc
  • Receptors, Thrombopoietin
  • Recombinant Fusion Proteins
  • Thrombopoietin
  • romiplostim
  • eltrombopag