<p>Cost- Effectiveness of Avatrombopag for the Treatment of Thrombocytopenia in Patients with Chronic Liver Disease</p>

Abstract

Background and Aim Thrombocytopenia is common in people with chronic liver disease, who frequently undergo invasive procedures. To minimize the risk of bleeding, prophylactic platelet transfusions have traditionally been used but carry many risks. The aim of this study was to evaluate the cost-effectiveness of avatrombopag compared with platelet transfusion and lusutrombopag as a treatment for thrombocytopenia in adult patients with chronic liver disease scheduled to undergo a medical procedure. Methods A decision-tree model was developed from a US payer perspective to capture acute events observed in phase 3 global randomized controlled clinical trials and, to support exploratory analyses, potential longer-term complications resulting from a major bleed or thromboembolic event. Treatment costs were taken from publicly available data sources. The interventions were evaluated in the overall trial populations and in subpopulations with higher and lower baseline platelet counts. Results were presented as incremental cost per platelet transfusion avoided. One-way and probabilistic sensitivity analyses were conducted. Results In the overall population, avatrombopag reduced the need for platelet transfusions and produced cost-savings compared with platelet transfusion (80% fewer prophylactic platelet transfusions, $4250 lower costs) and lusutrombopag (42% fewer prophylactic platelet transfusions, $5819 lower costs). Similar results were seen in both the higher and lower platelet count subpopulations. The one-way and probabilistic sensitivity analyses found that the use of avatrombopag is cost-saving with the incremental cost-effectiveness ratio in quadrant IV (decreased costs, prophylactic platelet transfusions avoided). Conclusion The use of avatrombopag is expected to be cost-saving while reducing the need for prophylactic platelet transfusions compared with platelet transfusion and lusutrombopag.

Thrombocytopenia and Hemostatic Changes in Acute and Chronic Liver Disease: Pathophysiology, Clinical and Laboratory Features, and Management

“…Several studies have assessed the clinical effectiveness in relation to the estimated cost-effectiveness of avatrombopag, lusutrombopag, and platelet transfusions. Some results of these analyses are equivocal or conflicting [ 91 , 92 , 93 , 94 ]. For example, Mladsi et al, reported that avatrombopag reduced the need for platelet transfusions and thus produced cost-savings compared with platelet transfusion (80% fewer prophylactic platelet transfusions, USD 4250 lower costs) or lusutrombopag (42% fewer platelet transfusions, USD 5820 lower costs) [ 91 , 92 ].…”

“…Some results of these analyses are equivocal or conflicting [ 91 , 92 , 93 , 94 ]. For example, Mladsi et al, reported that avatrombopag reduced the need for platelet transfusions and thus produced cost-savings compared with platelet transfusion (80% fewer prophylactic platelet transfusions, USD 4250 lower costs) or lusutrombopag (42% fewer platelet transfusions, USD 5820 lower costs) [ 91 , 92 ]. Others concluded from their cost-effectiveness analysis that avatrombopag and lusutrombopag are more expensive than no TPO receptor agonist over lifetime, as savings from avoiding platelet transfusions are exceeded by the drug cost and appear to be without long-term health benefits [ 93 ].…”

Avatrombopag: A Review in Thrombocytopenia

“…In the absence of a head-to-head study comparing avatrombopag and lusutrombopag in this indication, a network meta-analysis has found that more avatrombopag than lusutrombopag recipients achieved a platelet count ≥ 50 × 10 9 /L (odds ratio 3.40 [95% credible intervals 1.41 to 8.34]) with no significant between-treatment differences for other efficacy or safety outcomes revealed [ 41 ]. In a cost-efficacy analysis, avatrombopag was predicted to produce cost savings compared to platelet transfusions and lusutrombopag from a third-party US payer perspective in patients with thrombocytopenia associated with CLD scheduled to undergo an invasive procedure [ 42 ]. UK NICE guidance recommends the use of avatrombopag as an option (along with lusutrombopag) for treating severe thrombocytopenia in adults with CLD who have a planned invasive procedure [ 35 ] and posit that use of avatrombopag would highly likely reflect a good use of scarce NHS resources [ 35 ].…”

Cost-effectiveness analysis of multiple gastric cancer screening strategies in Northwest China based on a population program: a Markov modeling study

“…We conducted one-way and probabilistic sensitivity analyses to explore the effect of parameter uncertainty [30][31][32]. In the one-way sensitivity analyses, we used the minimum and maximum estimates for all key parameters, testing the in uence of extreme variations in each parameter on the overall results.…”