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• W3097604470 abstract "Splenectomy, thrombopoietin receptor agonists and rituximab are the second-line treatments for steroid-resistant adult primary immune thrombocytopenia. The last two are becoming the most widely used treatments to avoid splenectomy adverse effects and inconveniences. However, the choice between rituximab and thrombopoietin receptor agonists is unclear. Therefore, the treatment cost may be of particular interest to prioritize the therapy option. Our aim is to determine the cost per responding-patient after 6 months of use of rituximab compared to thrombopoietin receptor agonists eltrombopag in the treatment of chronic primary immune thrombocytopenia in the Spanish National Health Service.A 26-week decision tree model was developed to assess the cost of treatment response of adult patients with chronic-refractory primary immune thrombocytopenia to eltrombopag and rituximab from the perspective of the Spanish National Health System. Effectiveness was obtained 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 treatment was slightly higher for eltrombopag (€13,089.40) than for rituximab (€11,852.60). However, the greater response rate of eltrombopag decreases the bleeding costs, resulting in a 29% higher cost per responding-patient with rituximab (€18,964.15) than for eltrombopag (€14,732.65). This result is consistent with the results of the 15 sensitivity analyses carried out where eltrombopag always represents a lower cost per responding patient, except in the sensitivity analysis in which treatment with eltrombopag is performed at its maximum dose (75mg). Only in this case, the cost per responder of eltrombopag is €48 more expensive than that of rituximab. Likewise, the greatest difference in favor of eltrombopag occurs in the scenario that uses the minimum dose of this drug -25mg- (eltrombopag €7,622.14 compared to €18,964.15 for rituximab). Thus, the cost per responding patient is lower in eltrombopag even if a second cycle of retreatment with rituximab is not performed (€14,732.65 versus €15,298.61).The treatment cost of rituximab, including monitoring and bleeding costs, is higher than eltrombopag, favoring the latter over rituximab treatment.Objetivo: La esplenectomía, los agonistas del receptor de trombopoyetina y el rituximab son los tratamientos de segunda línea para la trombocitopenia inmune primaria. Los dos últimos se están convirtiendo en los más utilizados para evitar los efectos adversos de la esplenectomía. Sin embargo, la elección entre ambos no está clara. El coste puede ser de interés para priorizar el tratamiento. Nuestro objetivo es determinar el coste por paciente respondedor después de 6 meses de tratamiento de la trombocitopenia inmune primaria crónica con rituximab frente al agonista del receptor de trombopoyetina eltrombopag en el Sistema Nacional de Salud español.Método: Se desarrolló un modelo de árbol de decisión de 26 semanas para evaluar el coste de la respuesta al tratamiento con eltrombopag y rituximab en pacientes adultos con trombocitopenia inmune primaria crónica refractaria a esteroides. Debido al corto periodo de evaluación, no se aplicó tasa de descuento.Resultados: El coste medio por paciente tras 6 meses de tratamiento fue ligeramente superior para eltrombopag (13.089,40 €) que para rituximab (11.852,60 €). Sin embargo, la mayor tasa de respuesta de eltrombopag disminuye los costes de hemorragia, lo que se traduce en un coste por paciente respondedor un 29% mayor con rituximab (18.964,15 €) que con eltrombopag (14.732,65 €). Este resultado concuerda con los de los 15 análisis de sensibilidad realizados, donde eltrombopag siempre representa un menor coste por paciente respondedor, excepto cuando el tratamiento con eltrombopag se realiza en su dosis máxima (75 mg). Sólo en este caso, el coste por respondedor a eltrombopag es 48 € más caro que el del rituximab. En coherencia con lo anterior, la mayor diferencia a favor de eltrombopag se da en el escenario que utiliza la dosis mínima de éste —25 mg— (eltrombopag 7.622,14 € frente a 18.964,15 € de rituximab). Así, el coste por paciente respondedor es menor en eltrombopag aunque no se realice un segundo ciclo de retratamiento con rituximab (14.732,65 € frente a 15.298,61 €).Conclusiones: El coste del tratamiento con rituximab, incluidos los costes de monitorización y sangrado, es más alto que el de eltrombopag, lo cual favorece a este último por encima de rituximab." @default.
• W3097604470 created "2020-11-09" @default.
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• W3097604470 date "2020-10-15" @default.
• W3097604470 modified "2023-09-26" @default.
• W3097604470 title "Cost-per-responder analysis for eltrombopag and rituximab in the treatment of primary immune thrombocytopenia in Spain." @default.
• W3097604470 doi "https://doi.org/10.7399/fh.11525" @default.
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