. 2022 Feb 8;6(3):785-792.

doi: 10.1182/bloodadvances.2021005627.

Cost-effectiveness of eltrombopag vs intravenous immunoglobulin for the perioperative management of immune thrombocytopenia

Manraj N Kaur¹, Donald M Arnold^{2

3

4

5}, Nancy M Heddle^{2

3

6}, Richard J Cook⁷, Cyrus Hsia⁸, Mark Blostein⁹, Erin Jamula³, Michelle Sholzberg^{10

11

12

13}, Yulia Lin¹¹, Jeannine Kassis¹⁴, Loree Larratt¹⁵, Alan Tinmouth^{16

17}, Julie Carruthers³, Na Li^{3

18}, Yang Liu³, Feng Xie^{19

20}

Affiliations

¹ Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
² Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
³ Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
⁴ Canadian Blood Services, Hamilton, ON, Canada.
⁵ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
⁶ Centre for Innovation, Canada Blood Services, Ottawa, ON, Canada.
⁷ Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada.
⁸ Division of Hematology, Department of Medicine, University of Western Ontario, London, ON, Canada.
⁹ Department of Medicine, McGill University, Montreal, QC, Canada.
¹⁰ Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹² Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
¹³ University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada.
¹⁴ Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
¹⁵ Division of Hematology, University of Alberta, Edmonton, AB, Canada.
¹⁶ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁷ Centre for Innovation and Ottawa Hospital Centre for Transfusion Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
¹⁸ Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁹ Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; and.
²⁰ Centre for Health Economics and Policy Analysis, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

PMID: 34781363
PMCID: PMC8945289
DOI: 10.1182/bloodadvances.2021005627

Cost-effectiveness of eltrombopag vs intravenous immunoglobulin for the perioperative management of immune thrombocytopenia

Manraj N Kaur et al. Blood Adv. 2022.

. 2022 Feb 8;6(3):785-792.

doi: 10.1182/bloodadvances.2021005627.

Authors

Affiliations

¹ Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
² Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
³ Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
⁴ Canadian Blood Services, Hamilton, ON, Canada.
⁵ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
⁶ Centre for Innovation, Canada Blood Services, Ottawa, ON, Canada.
⁷ Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada.
⁸ Division of Hematology, Department of Medicine, University of Western Ontario, London, ON, Canada.
⁹ Department of Medicine, McGill University, Montreal, QC, Canada.
¹⁰ Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹² Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
¹³ University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, Toronto, ON, Canada.
¹⁴ Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
¹⁵ Division of Hematology, University of Alberta, Edmonton, AB, Canada.
¹⁶ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁷ Centre for Innovation and Ottawa Hospital Centre for Transfusion Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
¹⁸ Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁹ Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; and.
²⁰ Centre for Health Economics and Policy Analysis, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

PMID: 34781363
PMCID: PMC8945289
DOI: 10.1182/bloodadvances.2021005627

Abstract

Eltrombopag has been shown to be noninferior to intravenous immunoglobulin (IVIG) for improving perioperative platelet counts in patients with immune thrombocytopenia (ITP) in a randomized trial; thus, cost is an important factor for treatment and policy decisions. We used patient-level data from the trial to conduct a cost-effectiveness analysis comparing perioperative eltrombopag 50 mg daily starting dose, with IVIG 1 or 2 g/kg (according to local practice) from a Canadian public health care payer's perspective over the observation period, from preoperative day 21 to postoperative day 28. Resource utilization data were obtained from the trial data (eltrombopag, n = 38; IVIG, n = 36), and unit costs were collected from the Ontario Schedule of Benefits, Ontario Drug Formulary, and secondary sources. All costs were adjusted to 2020 Canadian dollars. We calculated the incremental cost per patient for all patients randomized. Uncertainty was addressed using nonparametric bootstrapping. The use of perioperative eltrombopag for patients with ITP resulted in a cost-saving of $413 Canadian per patient. Compared with IVIG, the probability of eltrombopag being cost effective was 70% even with no willingness to pay. In a sensitivity analysis based on IVIG dose, we found that with the higher dose of IVIG (2 g/kg), eltrombopag saved $2,714 per patient, whereas with the lower dose of IVIG (1 g/kg), eltrombopag had a higher mean cost of $562 per patient. In summary, based on data from the randomized trial that demonstrated noninferiority, the use of eltrombopag for the management of ITP in the perioperative setting was less costly than IVIG.

© 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.

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Figures

**Figure 1.**
Total cost associated with perioperative eltrombopag and intravenous immunoglobulin (IVIG) for patients with ITP.

**Figure 2.**
Incremental cost-effectiveness plane comparing eltrombopag with intravenous immunoglobulin.

**Figure 3.**
Cost-effectiveness acceptability curve showing the probability that eltrombopag is cost-effective compared with intravenous immunoglobulin over a range of willingness-to-pay values per rescue treatment averted.

See this image and copyright information in PMC

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Cost-effectiveness of eltrombopag vs intravenous immunoglobulin for the perioperative management of immune thrombocytopenia

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Cost-effectiveness of eltrombopag vs intravenous immunoglobulin for the perioperative management of immune thrombocytopenia

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