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Anticuerpos Monoclonales Humanizados , Azetidinas , Análisis Costo-Beneficio , Dermatitis Atópica , Purinas , Pirazoles , Sulfonamidas , Humanos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticuerpos Monoclonales Humanizados/economía , Azetidinas/uso terapéutico , Azetidinas/economía , Análisis de Costo-Efectividad , Dermatitis Atópica/tratamiento farmacológico , Dermatitis Atópica/economía , Italia , Purinas/uso terapéutico , Purinas/economía , Pirazoles/uso terapéutico , Pirazoles/economía , Índice de Severidad de la Enfermedad , Sulfonamidas/uso terapéutico , Sulfonamidas/economíaRESUMEN
INTRODUCTION: This study evaluates the cost-effectiveness of Apixaban and Rivaroxaban, compared to Warfarin, for stroke prevention in patients with non-valvular atrial fibrillation in Iran. METHOD: A Markov model with a 30-year time horizon was employed to simulate and assess different treatment strategies' cost-effectiveness. The study population comprised Iranian adults with NVAF, identified through specialist consultations, hospital visits, and archival record reviews. Direct medical costs, direct nonmedical, and indirect costs were included. Quality-adjusted life years (QALY) were assessed using an EQ-5D questionnaire. This study utilized a cost-effectiveness threshold of $11 134 per QALY. RESULTS: Apixaban demonstrated superior cost-effectiveness compared to Rivaroxaban and Warfarin. Over 30 years, total costs were lower in the Apixaban and Rivaroxaban groups compared to the Warfarin group ($126.18 and $109.99 vs. $150.49). However, Apixaban showed higher total QALYs gained compared to others (0.134 vs. 0.133 and 0.116). The incremental cost-effectiveness ratio for comparing Apixaban to Warfarin was calculated at -1332.83 cost per QALY, below the threshold of $11 134, indicating Apixaban's cost-effectiveness. Sensitivity analyses confirmed the robustness of the findings, with ICER consistently remaining below the threshold. Over 5 years (2024-2028) of Apixaban usage, the incremental cost starts at USD 70 250 296 in the first year and gradually rises to USD 71 770 662 in the fifth year. DSA and PSA were assessed to prove the robustness of the results. CONCLUSION: This study shows that Apixaban is a cost-effective option for stroke prevention in non-valvular atrial fibrillation patients in Iran compared to Warfarin.
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Anticoagulantes , Fibrilación Atrial , Análisis Costo-Beneficio , Inhibidores del Factor Xa , Pirazoles , Piridonas , Años de Vida Ajustados por Calidad de Vida , Rivaroxabán , Accidente Cerebrovascular , Warfarina , Humanos , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/economía , Pirazoles/uso terapéutico , Pirazoles/economía , Piridonas/economía , Piridonas/uso terapéutico , Warfarina/economía , Warfarina/uso terapéutico , Irán/epidemiología , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Rivaroxabán/economía , Rivaroxabán/uso terapéutico , Anticoagulantes/economía , Anticoagulantes/uso terapéutico , Masculino , Inhibidores del Factor Xa/economía , Inhibidores del Factor Xa/uso terapéutico , Femenino , Cadenas de Markov , Anciano , Costos de los Medicamentos , Resultado del Tratamiento , Persona de Mediana Edad , Presupuestos , Factores de TiempoRESUMEN
In recent years, newer drugs, such as ibrutinib, have shown promising improvements in the survival of patients with chronic lymphocytic leukemia (CLL). Despite their effectiveness, concerns about their cost have arisen, prompting the need for an evaluation of their cost-effectiveness. However, recent assessments of ibrutinib's cost-effectiveness for treating CLL in India reveal divergent conclusions. The discord centers on divergent cost-effectiveness thresholds, comparator regimens, cost calculations, and outcome valuation approaches. Such discrepancies affect public health decisions and patient care. The recommendation calls for adherence to methodological guidelines by future studies, fostering consistent findings to empower policy makers and clinicians in leveraging economic evidence for informed decision making in CLL treatment strategies.
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Adenina , Análisis Costo-Beneficio , Leucemia Linfocítica Crónica de Células B , Piperidinas , Pirazoles , Pirimidinas , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Leucemia Linfocítica Crónica de Células B/economía , Humanos , Adenina/análogos & derivados , Adenina/uso terapéutico , Adenina/economía , Análisis Costo-Beneficio/métodos , Piperidinas/uso terapéutico , Piperidinas/economía , India/epidemiología , Pirimidinas/economía , Pirimidinas/uso terapéutico , Pirazoles/economía , Pirazoles/uso terapéutico , Antineoplásicos/economía , Antineoplásicos/uso terapéuticoAsunto(s)
Aminofenoles , Benzodioxoles , Fibrosis Quística , Combinación de Medicamentos , Indoles , Pirazoles , Quinolonas , Humanos , Fibrosis Quística/tratamiento farmacológico , Fibrosis Quística/economía , Benzodioxoles/uso terapéutico , Benzodioxoles/farmacocinética , Aminofenoles/uso terapéutico , Aminofenoles/farmacocinética , Aminofenoles/economía , Quinolonas/uso terapéutico , Quinolonas/farmacocinética , Quinolonas/economía , Indoles/economía , Indoles/uso terapéutico , Indoles/farmacocinética , Pirazoles/uso terapéutico , Pirazoles/farmacocinética , Pirazoles/economía , Piridinas/farmacocinética , Piridinas/uso terapéutico , Piridinas/economía , Quinolinas/uso terapéutico , Quinolinas/farmacocinética , Quinolinas/economía , Costos de los Medicamentos , Accesibilidad a los Servicios de Salud/economía , Disparidades en Atención de Salud/economía , Agonistas de los Canales de Cloruro/uso terapéutico , Agonistas de los Canales de Cloruro/farmacocinética , Agonistas de los Canales de Cloruro/economía , Pirrolidinas/uso terapéutico , Pirrolidinas/farmacocinéticaRESUMEN
BACKGROUND: Lung cancer is the leading cause of cancer death in the United States. Non-small cell lung cancer (NSCLC) accounts for 80% to 85% of all lung cancers. Thyroid cancer, while generally not as lethal as lung cancer, has a large prevalent population and a rapidly increasing incidence in the United States. Pralsetinib is a highly potent, selective rearranged during transfection (RET) inhibitor indicated for the treatment of RET-positive NSCLC and thyroid cancer tumors. OBJECTIVE: To estimate the budget impact of adding pralsetinib to a 1 million-member US health plan formulary for the treatment of patients with metastatic RET fusion-positive NSCLC, advanced or metastatic RET-mutant medullary thyroid cancer (MTC), or advanced or metastatic RET fusion-positive thyroid cancer (non-MTC). METHODS: A budget impact model with a 3-year time horizon was developed in Microsoft Excel to estimate the number of eligible RET-positive NSCLC and thyroid cancer patients in a plan and quantify associated treatment costs (2020 USD). Comparators in the analyses included pralsetinib, selpercatinib, and cabozantinib, as well as indication-specific use of pembrolizumab, pemetrexed/carboplatin combination, vandetanib, lenvatinib, and sorafenib. Drug acquisition, molecular testing, treatment monitoring, and adverse event management costs were included to estimate total annual costs and per-member per-month (PMPM) costs in current (without pralsetinib) and potential future market scenarios, where pralsetinib is assumed to split the projected RET inhibitor market share with selpercatinib. The number of treated patients was based on age- and sex-adjusted incidence of disease, the proportion of patients diagnosed with advanced or metastatic disease, and projected RET testing rates. Treatment duration was based on progression-free survival or duration of response data from clinical trials. Medical resources were monetized using standardized sources such as Medicare reimbursement and wholesale acquisition cost (WAC). RESULTS: The model estimated that there would be approximately 6 new treatment-eligible patients in a 1 million-member plan annually. Monthly WAC is $19,243 for pralsetinib and $20,600 for selpercatinib at the recommended starting dose. Adoption of pralsetinib, with corresponding increases in pralsetinib market share, would be slightly cost saving to a payer, decreasing the overall budget impact to the health plan by $49,985 in year 3 (-$0.0042 PMPM; -$0.0030, -$0.0006, and -$0.0005 for NSCLC, MTC, and thyroid cancer [non-MTC], respectively). In year 3, drug costs were the key driver of total costs (~80%-98%) and cost savings. All other medical resource categories were cost-neutral or nominally cost saving or additive in the budget impact analysis. CONCLUSIONS: Quantifying the budget impact associated with the adoption of new targeted precision therapies is an important consideration for payers. For eligible NSCLC and thyroid cancer patients, our analysis suggests that adoption of pralsetinib is expected to result in modest cost savings for US payers. DISCLOSURES: Support for this study was provided by Blueprint Medicines Corporation. This study was conducted by Veritas Health Economics Consulting, Inc., in collaboration with Blueprint Medicines, which was involved in the design of the study; collection, analysis, and interpretation of the data; writing of the report; and the decision to submit the report for publication. Duff is an employee of Veritas Health Economics Consulting, which received research funding from Blueprint Medicines to develop the budget impact model. Norregaard and Sullivan are employees of Blueprint Medicines. Bargiacchi and Brener were employees of Blueprint Medicines at the time of the research study. This study was presented as a poster at the AMCP Virtual Learning Event, April 2021.
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Antineoplásicos/economía , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Formularios Farmacéuticos como Asunto , Neoplasias Pulmonares/tratamiento farmacológico , Pirazoles/economía , Piridinas/economía , Pirimidinas/economía , Neoplasias de la Tiroides/tratamiento farmacológico , Presupuestos , Carcinoma de Pulmón de Células no Pequeñas/genética , Humanos , Neoplasias Pulmonares/genética , Modelos Económicos , Proteínas Proto-Oncogénicas c-ret , Neoplasias de la Tiroides/genética , Estados UnidosRESUMEN
BACKGROUND/OBJECTIVE: AUGUSTUS trial demonstrated that, for patients with atrial fibrillation (AF) having acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI), an antithrombotic regimen with apixaban and P2Y12 resulted in less bleeding, fewer hospitalizations, and similar ischemic events than regimens including a vitamin K antagonist (VKA), aspirin, or both. This study objective was to evaluate long-term health and economic outcomes and the cost-effectiveness of apixaban over VKA, as a treatment option for patients with AF having ACS/PCI. METHODS: A lifetime Markov cohort model was developed comparing apixaban versus VKA across multiple treatment strategies (triple [with P2Y12 + aspirin] or dual [with P2Y12] therapy followed by monotherapy [apixaban or VKA]; triple followed by dual and then monotherapy; dual followed by monotherapy). The model adopted the Spanish healthcare perspective, with a 3-month cycle length and costs and health outcomes discounted at 3%. RESULTS: Treatment with apixaban resulted in total cost savings of 883 and higher life years (LYs) and quality-adjusted LYs (QALYs) per patient than VKA (net difference, LYs: 0.13; QALYs: 0.11). Bleeding and ischemic events (per 100 patients) were lower with apixaban than VKA (net difference, -13.9 and -1.8, respectively). Incremental net monetary benefit for apixaban was 3,041, using a willingness-to-pay threshold of 20,000 per QALY. In probabilistic sensitivity analysis, apixaban was dominant in the majority of simulations (92.6%), providing additional QALYs at lower costs than VKA. CONCLUSIONS: Apixaban was a dominant treatment strategy than VKA from both the Spanish payer's and societal perspectives, regardless of treatment strategy considered.
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Aspirina/economía , Fibrilación Atrial/tratamiento farmacológico , Análisis Costo-Beneficio , Fibrinolíticos/economía , Pirazoles/economía , Piridonas/economía , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/patología , Anciano , Aspirina/uso terapéutico , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Cadenas de Markov , Intervención Coronaria Percutánea/efectos adversos , Pirazoles/uso terapéutico , Piridonas/uso terapéutico , Años de Vida Ajustados por Calidad de Vida , EspañaRESUMEN
BACKGROUND: Promacta (eltrombopag; EPAG) and Nplate (romiplostim; ROMI) have not been compared in head-to-head trials for treatment of chronic immune thrombocytopenia (cITP); however, indirect treatment comparisons have indicated similar efficacy and safety outcomes, and the drugs are generally accepted as therapeutic alternatives. OBJECTIVE: To determine which of the 2 therapies would result in the lowest overall cost from a US health plan perspective, under the assumption of equivalent clinical efficacy and safety. METHODS: A cost-minimization model was developed in Microsoft Excel. The model incorporated only costs that differ between the treatments, including drug acquisition, administration, and monitoring costs, over a 52-week horizon. Average dosing for EPAG and ROMI was taken from the long-term EXTEND trial and from a published metaanalysis of 14 clinical trials, respectively. ROMI is injectable and EPAG is oral, so only ROMI had administration costs. The model assumed patients used 25 mg EPAG tablets and the 250 µg vial size of ROMI. ROMI wastage was included in drug acquisition costs by rounding up average dose to the nearest whole vial. Monitoring requirements were determined from US prescribing information, with platelet monitoring assumed equal, and hepatic panel testing every 4 weeks for EPAG. The model was adjustable to commercial, Medicare, and Medicaid plan perspectives, with optional inclusion of drug wastage, monitoring, or administration costs. RESULTS: The base case used a commercial plan perspective, with average dosing of 51.5 mg/day for EPAG and 4.20 µg/kg/week for ROMI. The analysis found a cost difference per treated patient of $64,770 in favor of EPAG on an annual basis. Breakdown by unique costs for EPAG included drug-acquisition cost of $123,135 and monitoring cost of $705. Breakdown by unique costs for ROMI included drug-acquisition cost of $183,234, with wastage of $63,179 and administration cost of $5,377. Based on a hypothetical commercial plan with 1 million members and an estimated 11 patients with cITP receiving ROMI, potential annual savings for switching all patients from ROMI to EPAG is $712,473 or $0.06 per member per month. EPAG remained the less costly option for all plan types and assumptions. A sensitivity analysis found that the result was most sensitive to drug pricing and wastage inputs. CONCLUSIONS: Because of lower drug-acquisition costs (including drug wastage) and administration costs, treatment of cITP with EPAG is associated with a lower net cost per patient than ROMI. DISCLOSURES: This study was funded by Novartis Pharmaceuticals Corporation. Proudman, Lucas, and Nellesen are employees of Analysis Group, Inc., which received funding from Novartis Pharmaceuticals Corporation to conduct this study. Patwardhan was employed by Novartis Pharmaceuticals Corporation at the time of this study; Allen is an employee of Novartis. This research was presented as an e-poster at the AMCP 2020 Virtual, April 2020.
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Benzoatos/economía , Enfermedad Crónica/economía , Hidrazinas/economía , Pirazoles/economía , Proteínas Recombinantes de Fusión/economía , Trombocitopenia/tratamiento farmacológico , Trombopoyetina/economía , Adolescente , Adulto , Control de Costos , Costos de los Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Receptores Fc , Estados Unidos , Adulto JovenRESUMEN
DISCLOSURES: No funding contributed to the writing of this commentary. Both authors are employed by the Cystic Fibrosis Foundation. The Cystic Fibrosis Foundation has entered into therapeutic development award agreements and licensing agreements to assist with the development of CFTR modulators that may result in intellectual property rights, royalties, and other forms of consideration provided to CFF. Some of these agreements are subject to confidentiality restrictions and, thus, CFF cannot comment on them.
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Agonistas de los Canales de Cloruro/uso terapéutico , Regulador de Conductancia de Transmembrana de Fibrosis Quística/agonistas , Fibrosis Quística/tratamiento farmacológico , Costos de los Medicamentos , Aminofenoles/economía , Aminofenoles/uso terapéutico , Benzodioxoles/economía , Benzodioxoles/uso terapéutico , Agonistas de los Canales de Cloruro/economía , Fibrosis Quística/economía , Fibrosis Quística/genética , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Aprobación de Drogas/economía , Combinación de Medicamentos , Humanos , Indoles/economía , Indoles/uso terapéutico , Asistencia Médica , Mutación , Pirazoles/economía , Pirazoles/uso terapéutico , Piridinas/economía , Piridinas/uso terapéutico , Quinolinas/economía , Quinolinas/uso terapéutico , Quinolonas/economía , Quinolonas/uso terapéutico , Resultado del Tratamiento , Estados Unidos , United States Food and Drug AdministrationRESUMEN
DISCLOSURES: Funding for this summary was contributed by Arnold Ventures, California Health Care Foundation, Harvard Pilgrim Health Care, and Kaiser Foundation Health Plan to the Institute for Clinical and Economic Review (ICER), an independent organization that evaluates the evidence on the value of health care interventions. ICER's annual policy summit is supported by dues from Aetna, America's Health Insurance Plans, Anthem, Allergan, Alnylam, AstraZeneca, Biogen, Blue Shield of CA, Boehringer-Ingelheim, Cambia Health Services, CVS, Editas, Express Scripts, Genentech/Roche, GlaxoSmithKline, Harvard Pilgrim, Health Care Service Corporation, HealthFirst, Health Partners, Johnson & Johnson (Janssen), Kaiser Permanente, LEO Pharma, Mallinckrodt, Merck, Novartis, National Pharmaceutical Council, Pfizer, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark Therapeutics, and United Healthcare. Seidner, Rind, and Pearson are employed by ICER. Tice reports contracts to his institution, University of California, San Francisco, from ICER during the conduct of this study. Wherry has nothing to disclose.
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Agonistas de los Canales de Cloruro/uso terapéutico , Análisis Costo-Beneficio , Regulador de Conductancia de Transmembrana de Fibrosis Quística/agonistas , Fibrosis Quística/tratamiento farmacológico , Modelos Económicos , Adolescente , Aminofenoles/economía , Aminofenoles/uso terapéutico , Aminopiridinas/economía , Aminopiridinas/uso terapéutico , Benzodioxoles/economía , Benzodioxoles/uso terapéutico , Niño , Agonistas de los Canales de Cloruro/economía , Fibrosis Quística/economía , Fibrosis Quística/genética , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Aprobación de Drogas/economía , Combinación de Medicamentos , Costos de los Medicamentos , Política de Salud/economía , Humanos , Indoles/economía , Indoles/uso terapéutico , Mutación , Pirazoles/economía , Pirazoles/uso terapéutico , Piridinas/economía , Piridinas/uso terapéutico , Quinolinas/economía , Quinolinas/uso terapéutico , Quinolonas/economía , Quinolonas/uso terapéutico , Resultado del Tratamiento , Estados Unidos , United States Food and Drug AdministrationRESUMEN
BACKGROUND: Apixaban (2.5 mg) taken twice daily has been shown to substantially reduce the risk of venous thromboembolism (VTE) compared with placebo for the primary thromboprophylaxis of ambulatory patients with cancer who are starting chemotherapy and are at intermediate-to-high risk of VTE. We aimed to compare the health system costs and health benefits associated with primary thromboprophylaxis using apixaban with those associated with the current standard of care (where no primary thromboprophylaxis is given), from the perspective of Canada's publicly funded health care system in this subpopulation of patients with cancer over a lifetime horizon. METHODS: We performed a cost-utility analysis to estimate the incremental cost per quality-adjusted life-year (QALY) gained with primary thromboprophylaxis using apixaban. We obtained baseline event rates and the efficacy of apixaban from the Apixaban for the Prevention of Venous Thromboembolism in High-Risk Ambulatory Cancer Patients (AVERT) trial on apixaban prophylaxis. We estimated relative risk for bleeding, risk of complications associated with VTE treatment, mortality rates, costs and utilities from other published sources. RESULTS: Over a lifetime horizon, apixaban resulted in lower costs to the health system (Can$7902.98 v. Can$14 875.82) and an improvement in QALYs (9.089 v. 9.006). The key driver of cost-effectiveness results was the relative risk of VTE as a result of apixaban. Results from the probabilistic analysis showed that at a willingness to pay of Can$50 000 per QALY, the strategy with the highest probability of being most cost-effective was apixaban, with a probability of 99.87%. INTERPRETATION: We found that apixaban is a cost-saving option for the primary thromboprophylaxis of ambulatory patients with cancer who are starting chemotherapy and are at intermediate-to-high risk of VTE.
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Análisis Costo-Beneficio , Inhibidores del Factor Xa/uso terapéutico , Costos de la Atención en Salud , Neoplasias/tratamiento farmacológico , Pirazoles/uso terapéutico , Piridonas/uso terapéutico , Tromboembolia Venosa/prevención & control , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Árboles de Decisión , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/economía , Hemorragia/inducido químicamente , Humanos , Pirazoles/efectos adversos , Pirazoles/economía , Piridonas/efectos adversos , Piridonas/economía , Años de Vida Ajustados por Calidad de Vida , Factores de RiesgoRESUMEN
BACKGROUND: Darolutamide, a structurally distinct androgen receptor inhibitor approved for the treatment of men with nonmetastatic castration-resistant prostate cancer (nmCRPC), has been shown to increase metastasis-free survival among men with nmCRPC compared with placebo. This treatment has a novel chemical structure that may also have safety, tolerability, and efficacy advantages for men with nmCRPC. OBJECTIVE: To estimate the projected budget impact of including darolutamide on a U.S. payer formulary as a treatment option for men with nmCRPC. METHODS: A budget impact model was developed to evaluate darolutamide for nmCRPC for a hypothetical 1-million-member plan over a 5-year period. Costs (drug acquisition, drug administration, and treatment-related adverse events [AEs]) were estimated for 2 scenarios: with and without darolutamide treatment for nmCRPC. The budget impact of darolutamide was calculated as the difference in costs for these 2 scenarios. An analysis for high-risk nmCRPC also was conducted. The model included treatments recommended by the National Comprehensive Cancer Network (e.g., apalutamide and enzalutamide) and potential comparators that are used but are not specifically indicated for nmCRPC. All treatments were assumed to be administered in combination with a weighted average androgen deprivation therapy comparator (consisting of luteinizing hormone-releasing hormone [LHRH] agonists, LHRH antagonists, and first-generation antiandrogens). Market share estimates were derived from interviews with physicians treating men with nmCRPC. The model includes grade 3-4 AEs, and the rates were obtained from clinical trial data. Costs were taken from publicly available sources and varied in a one-way sensitivity analysis. RESULTS: For a plan with 1 million lives, there were approximately 90 incident cases of nmCRPC (46 high risk) each year, with 332 (109 high risk) treatment-eligible cases by year 5. Darolutamide's market share increased from 3.6% in year 1 to 18% in year 5. Given the utilization of other agents, introducing darolutamide along with other targeted therapies was predicted to increase the total budget by $158,640 ($0.0132 per member per month [PMPM]) in year 1, which decreased over time to a cost savings of $149,240 ($0.0124 PMPM) by year 5. The scenario with darolutamide showed reduced AE costs each year. Similar results were observed for the high-risk nmCRPC population. CONCLUSIONS: Adding darolutamide to a U.S. payer formulary for the treatment of nmCRPC can result in a manageable increase in the budget that is partly offset by AE costs in the first 4 years, followed by a cost savings by year 5. DISCLOSURES: This study was conducted by RTI Health Solutions under the direction of Bayer U.S. and was funded by Bayer U.S., which was involved in the design of the study; collection, analysis, and interpretation of the data; writing of the report; and the decision to submit the report for publication. Miles and Purser (and/or their institutions) are employees of RTI Health Solutions and received research funding from Bayer U.S. to develop the budget impact model. Appukkuttan and Farej are employees of Bayer U.S. Wen was an employee of Bayer U.S. at the time of the study. This study was presented as a poster at the AMCP Virtual Learning Event, April 20-24, 2020.
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Antagonistas de Andrógenos/uso terapéutico , Presupuestos/estadística & datos numéricos , Neoplasias de la Próstata Resistentes a la Castración/tratamiento farmacológico , Pirazoles/uso terapéutico , Antagonistas de Andrógenos/economía , Benzamidas/economía , Benzamidas/uso terapéutico , Ahorro de Costo/estadística & datos numéricos , Costos de los Medicamentos/estadística & datos numéricos , Humanos , Masculino , Modelos Económicos , Nitrilos/economía , Nitrilos/uso terapéutico , Feniltiohidantoína/economía , Feniltiohidantoína/uso terapéutico , Supervivencia sin Progresión , Neoplasias de la Próstata Resistentes a la Castración/economía , Neoplasias de la Próstata Resistentes a la Castración/mortalidad , Pirazoles/economía , Tiohidantoínas/economía , Tiohidantoínas/uso terapéutico , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: Several direct oral anticoagulants (DOACs) have been approved by the European Medicines Agency since 2008. The aim of the present cost-effectiveness-analysis was to analyze apixaban compared to other DOACs and vitamin K antagonists (warfarin) in Austria. METHODS: A cost-utility-model was developed to simulate lifetime-costs and quality-adjusted-life-years of DOACs and warfarin, based on a published Markov-Model and 23 randomized trials with 94,656 atrial-fibrillation (AF) patients. Each year, a patient has a probability of suffering a clinically relevant (extracranial) bleed, an intracranial hemorrhage (ICH), an ischemic stroke or a myocardial infarction (MI), remaining healthy, or deceasing. Direct-costs (2018) were derived from published sources from the payer's perspective. RESULTS: In the base-case, warfarin had the lowest cost of 12,968 (95%-CI±593 ) followed by apixaban (15,269 ±661 ), edoxaban (15,534 ±641 ), dabigatran (15,687 ±667 ), and rivaroxaban (17,522 ±764 ). Apixaban had the highest quality-adjusted-life-years estimate at 5.45 (SD, 0.06). In a Monte-Carlo probabilistic sensitivity analysis, apixaban was cost-effective vs. edoxaban, dabigatran, warfarin, and rivaroxaban in 85.6%, 79.0%, 76.4%, and 61.2% of the simulations, respectively. CONCLUSION: In patients with AF and an increased risk of stroke, prophylaxis with apixaban was highly cost-effective from the perspective of the Austrian health-care system.
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Fibrilación Atrial/tratamiento farmacológico , Inhibidores del Factor Xa/administración & dosificación , Pirazoles/administración & dosificación , Piridonas/administración & dosificación , Accidente Cerebrovascular/prevención & control , Anciano , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Anticoagulantes/economía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/economía , Austria , Análisis Costo-Beneficio , Inhibidores del Factor Xa/economía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Econométricos , Pirazoles/economía , Piridonas/economía , Años de Vida Ajustados por Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/etiología , Warfarina/administración & dosificación , Warfarina/economíaRESUMEN
BACKGROUND: In patients with atrial fibrillation, incomplete adherence to anticoagulants increases risk of stroke. Non-warfarin oral anticoagulants (NOACs) are expensive; we evaluated whether higher copayments are associated with lower NOAC adherence. METHODS: Using a national claims database of commercially-insured patients, we performed a cohort study of patients with atrial fibrillation who newly initiated a NOAC from 2012 to 2018. Patients were stratified into low (<$35), medium ($35-$59), or high (≥$60) copayments and propensity-score weighted based on demographics, insurance characteristics, comorbidities, prior health care utilization, calendar year, and the NOAC received. Follow-up was 1 year, with censoring for switching to a different anticoagulant, undergoing an ablation procedure, disenrolling from the insurance plan, or death. The primary outcome was adherence, measured by proportion of days covered (PDC). Secondary outcomes included NOAC discontinuation (no refill for 30 days after the end of NOAC supply) and switching anticoagulants. We compared PDC using a Kruskal-Wallis test and rates of discontinuation and switching using Cox proportional hazards models. RESULTS: After weighting patients across the 3 copayment groups, the effective sample size was 17,558 patients, with balance across 50 clinical and demographic covariates (standardized differences <0.1). Mean age was 62 years, 29% of patients were female, and apixaban (43%), and rivaroxaban (38%) were the most common NOACs. Higher copayments were associated with lower adherence (P < .001), with a PDC of 0.82 (Interquartile range [IQR] 0.36-0.98) among those with high copayments, 0.85 (IQR 0.41-0.98) among those with medium copayments, and 0.88 (IQR 0.41-0.99) among those with low copayments. Compared to patients with low copayments, patients with high copayments had higher rates of discontinuation (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.08-1.19; P < .001). CONCLUSIONS: Among atrial fibrillation patients newly initiating NOACs, higher copayments in commercial insurance were associated with lower adherence and higher rates of discontinuation in the first year. Policies to lower or limit cost-sharing of important medications may lead to improved adherence and better outcomes among patients receiving NOACs.
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Fibrilación Atrial/complicaciones , Deducibles y Coseguros/economía , Cumplimiento de la Medicación/estadística & datos numéricos , Accidente Cerebrovascular/prevención & control , Anticoagulantes/economía , Anticoagulantes/uso terapéutico , Antitrombinas/economía , Antitrombinas/uso terapéutico , Estudios de Cohortes , Dabigatrán/economía , Dabigatrán/uso terapéutico , Bases de Datos Factuales/estadística & datos numéricos , Deducibles y Coseguros/estadística & datos numéricos , Costos de los Medicamentos , Inhibidores del Factor Xa/economía , Inhibidores del Factor Xa/uso terapéutico , Femenino , Humanos , Masculino , Medicare Part C/estadística & datos numéricos , Persona de Mediana Edad , Pirazoles/economía , Pirazoles/uso terapéutico , Piridinas/economía , Piridinas/uso terapéutico , Piridonas/economía , Piridonas/uso terapéutico , Rivaroxabán/economía , Rivaroxabán/uso terapéutico , Tamaño de la Muestra , Accidente Cerebrovascular/etiología , Tiazoles/economía , Tiazoles/uso terapéutico , Estados Unidos , Warfarina/economía , Warfarina/uso terapéuticoRESUMEN
Importance: With the approval of avapritinib for adults with unresectable or metastatic gastrointestinal stromal tumors (GISTs) harboring a platelet-derived growth factor receptor alpha (PDGFRA) exon 18 variant, including PDGFRA D842V variants, and National Comprehensive Cancer Network guideline recommendations as an option for patients with GIST after third-line treatment, it is important to estimate the potential financial implications of avapritinib on a payer's budget. Objective: To estimate the budget impact associated with the introduction of avapritinib to a formulary for metastatic or unresectable GISTs in patients with a PDGFRA exon 18 variant or after 3 or more previous treatments from the perspective of a US health plan. Design, Setting, and Participants: For this economic evaluation, a 3-year budget impact model was developed in March 2020, incorporating costs for drug acquisition, testing, monitoring, adverse events, and postprogression treatment. The model assumed that avapritinib introduction would be associated with increased PDGFRA testing rates from the current 49% to 69%. The health plan population was assumed to be mixed 69% commercial, 22% Medicare, and 9% Medicaid. Base case assumptions included a GIST incidence rate of 9.6 diagnoses per million people, a metastatic PDGFRA exon 18 mutation rate of 1.9%, and progression rate from first-line to fourth-line treatment of 17%. Exposures: The model compared scenarios with and without avapritinib in a formulary. Main Outcomes and Measures: Annual, total, and per member per month (PMPM) budget impact. Results: In a hypothetical 1-million member plan, fewer than 0.1 new patients with a PDGFRA exon 18 variant per year and 1.2 patients receiving fourth-line therapy per year were eligible for treatment. With avapritinib available, the total increase in costs in year 3 for all eligible adult patients with a PDGFRA exon 18 variant was $46â¯875, or $0.004 PMPM. For patients undergoing fourth-line treatment, the total increase in costs in year 3 was $69â¯182, or $0.006 PMPM. The combined total budget impact in year 3 was $115â¯604, or $0.010 PMPM, including an offset of $3607 in postprogression costs avoided or delayed. The higher rates of molecular testing resulted in a minimal incremental testing cost of $453 in year 3. Conclusions and Relevance: These results suggest that adoption of avapritinib as a treatment option would have a minimal budget impact to a hypothetical US health plan. This would be primarily attributable to the small eligible patient population and cost offsets from reduced or delayed postprogression costs.
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Antineoplásicos/economía , Neoplasias Gastrointestinales/tratamiento farmacológico , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Programas Controlados de Atención en Salud/economía , Pirazoles/economía , Pirroles/economía , Triazinas/economía , Antineoplásicos/uso terapéutico , Presupuestos , Análisis Costo-Beneficio , Formularios Farmacéuticos como Asunto , Neoplasias Gastrointestinales/patología , Tumores del Estroma Gastrointestinal/genética , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/secundario , Humanos , Mesilato de Imatinib/economía , Mesilato de Imatinib/uso terapéutico , Indazoles , Medicaid , Medicare , Técnicas de Diagnóstico Molecular/economía , Compuestos de Fenilurea/economía , Compuestos de Fenilurea/uso terapéutico , Pirazoles/uso terapéutico , Piridinas/economía , Piridinas/uso terapéutico , Pirimidinas/economía , Pirimidinas/uso terapéutico , Pirroles/uso terapéutico , Receptor alfa de Factor de Crecimiento Derivado de Plaquetas/genética , Sulfonamidas/economía , Sulfonamidas/uso terapéutico , Sunitinib/economía , Sunitinib/uso terapéutico , Insuficiencia del Tratamiento , Triazinas/uso terapéutico , Estados UnidosRESUMEN
BACKGROUND: Antithrombotic drugs decrease stroke risk in patients with atrial fibrillation, but they increase bleeding risk, particularly in older adults at high risk for falls. We aimed to determine the most cost-effective antithrombotic therapy in older adults with atrial fibrillation who are at high risk for falls. METHODS: We conducted a mathematical modelling study from July 2019 to March 2020 based on the Ontario, Canada, health care system. We derived the base-case age, sex and fall risk distribution from a published cohort of older adults at risk for falls, and the bleeding and stroke risk parameters from an atrial fibrillation trial population. Using a probabilistic microsimulation Markov decision model, we calculated quality-adjusted life years (QALYs), total cost and incremental cost-effectiveness ratios (ICERs) for each of acetylsalicylic acid (ASA), warfarin, apixaban, dabigatran, rivaroxaban and edoxaban. Cost data were adjusted for inflation to 2018 values. The analysis used the Ontario public payer perspective with a lifetime horizon. RESULTS: In our model, the most cost-effective antithrombotic therapy for atrial fibrillation in older patients at risk for falls was apixaban, with an ICER of $8517 per QALY gained (5.86 QALYs at $92 056) over ASA. It was a dominant strategy over warfarin and the other antithrombotic agents. There was moderate uncertainty in cost-effectiveness ranking, with apixaban as the preferred choice in 66% of model iterations (given willingness to pay of $50 000 per QALY gained); edoxaban, 30 mg, was preferred in 31% of iterations. Sensitivity analysis across ranges of age, bleeding risk and fall risk still favoured apixaban over the other medications. INTERPRETATION: From a public payer perspective, apixaban is the most cost-effective antithrombotic agent in older adults at high risk for falls. Health care funders should implement strategies to encourage use of the most cost-effective medication in this population.
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Accidentes por Caídas/prevención & control , Fibrilación Atrial/complicaciones , Análisis Costo-Beneficio , Fibrinolíticos/economía , Accidente Cerebrovascular/prevención & control , Accidentes por Caídas/economía , Anciano , Anciano de 80 o más Años , Aspirina/economía , Aspirina/farmacología , Fibrilación Atrial/tratamiento farmacológico , Dabigatrán/economía , Dabigatrán/farmacología , Femenino , Fibrinolíticos/farmacología , Hemorragia/inducido químicamente , Hemorragia/prevención & control , Humanos , Masculino , Modelos Teóricos , Ontario , Pirazoles/economía , Pirazoles/farmacología , Piridinas/economía , Piridinas/farmacología , Piridonas/economía , Piridonas/farmacología , Años de Vida Ajustados por Calidad de Vida , Rivaroxabán/economía , Rivaroxabán/farmacología , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/etiología , Tiazoles/economía , Tiazoles/farmacología , Warfarina/efectos adversos , Warfarina/economía , Warfarina/farmacologíaRESUMEN
OBJECTIVES: To provide the most current assessment of real-world healthcare resource utilization (HRU) and costs among patients with non-valvular atrial fibrillation (NVAF) who newly initiated rivaroxaban and apixaban using a large US database. MATERIAL AND METHODS: A retrospective weighted cohort design was used with healthcare insurance claims from the Optum Clinformatics Data Mart databases (January 2012-December 2018). The index date was defined as the first dispensing of rivaroxaban or apixaban. Adult NVAF patients with an index date on or after 1 January 2016, ≥ 12 months of continuous eligibility before the index date and ≥ 1 month after, and without prior use of oral anticoagulant were included. The observation period spanned from the index date to the earliest of the end of data availability, end of insurance coverage, or death. Inverse probability of treatment weighting (IPTW) was used to adjust for differences in baseline characteristics between cohorts. All-cause healthcare resource utilization (HRU), including hospitalization, emergency room, and outpatient visits, and healthcare costs, including medical and pharmacy costs, were evaluated from the payer's perspective during the observation period up to 18 and 24 months, separately. RESULTS: In total, 23,822 rivaroxaban and 53,666 apixaban users were included. After weighting, all baseline characteristics were well balanced between cohorts (mean age: 73.8 years, female: 46.6% in both cohorts). Up to 18 months of follow-up, rivaroxaban users incurred significantly lower total healthcare costs compared to apixaban users (cost difference = -$1,121; p = 0.020), driven by significantly lower rates of outpatient hospital visits and associated costs (cost difference = -$1,579; p < 0.001). Similar results were found in the analysis conducted for up to 24 months of follow-up (total cost difference = â$1,111; p = 0.020). CONCLUSIONS: In this large retrospective analysis, patients with NVAF initiated on rivaroxaban incurred significantly lower healthcare costs compared to those initiated on apixaban, which were primarily driven by significantly lower outpatient visits and costs during the 18- and 24-month follow-up periods.
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Anticoagulantes/economía , Fibrilación Atrial/tratamiento farmacológico , Gastos en Salud/estadística & datos numéricos , Pirazoles/economía , Piridonas/economía , Rivaroxabán/economía , Anciano , Anticoagulantes/uso terapéutico , Femenino , Humanos , Revisión de Utilización de Seguros , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Pirazoles/uso terapéutico , Piridonas/uso terapéutico , Estudios Retrospectivos , Rivaroxabán/uso terapéutico , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/prevención & control , Estados UnidosRESUMEN
OBJECTIVE: The cost-effectiveness of apixaban was compared with enoxaparin for prevention of postoperative venothromboembolic events (VTE) in gynecologic oncology patients. Current guidelines recommend thromboprophylaxis with low molecular weight heparin for 28 days following gynecologic cancer surgery, but recent trials suggest that oral apixaban may be a safe, patient-preferred alternative. Apixaban was superior to enoxaparin in a Canadian cost-effectiveness analysis using orthopedics trial data. METHODS: Medication costs, adherence rates, event rates, event costs, and utility decrements were estimated using prior clinical trial data and literature review for input into a short-term decision model to simulate outcomes in a hypothetical cohort of 1000 patients. Incremental cost-effectiveness ratios (ICERs) were calculated as net cost difference per quality-adjusted life year (QALY) gained. Input values at which net costs and QALYs were equivalent and ICERs at upper and lower bounds were evaluated. RESULTS: Using aggregated costs, apixaban was less expensive and more effective than enoxaparin, and remained so or had high value in all scenarios on sensitivity analysis. Examining disaggregated ICERs, apixaban was cost-effective for deep venous thrombosis (DVT); of high value for clinically-relevant non-major bleeding (CRNMB) ($411); low value for major bleeding ($183,465), VTE-related death ($2,711,229), and all-cause mortality ($297,522); and not cost-effective for pulmonary embolism prevention. CONCLUSIONS: Apixaban is more cost-effective than enoxaparin for the prevention of postoperative VTE in patients with gynecologic cancer. This appears to be driven largely by DVT and CRNMB prevention.
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Enoxaparina/economía , Fibrinolíticos/economía , Hemorragia Posoperatoria/prevención & control , Pirazoles/economía , Piridonas/economía , Tromboembolia Venosa/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Enoxaparina/uso terapéutico , Femenino , Fibrinolíticos/administración & dosificación , Neoplasias de los Genitales Femeninos/cirugía , Humanos , Persona de Mediana Edad , Hemorragia Posoperatoria/etiología , Pirazoles/uso terapéutico , Piridonas/uso terapéutico , Años de Vida Ajustados por Calidad de Vida , Tromboembolia Venosa/etiologíaRESUMEN
BACKGROUND: Direct-acting oral anticoagulants are indicated for the treatment of nonvalvular atrial fibrillation, but their use in patients after undergoing cardiac surgery is poorly defined despite a high prevalence of postoperative atrial fibrillation in this population. METHODS: Patients diagnosed with postoperative atrial fibrillation were prospectively randomized to warfarin or apixaban. Safety, efficacy, and economic outcomes were evaluated until their 4- to 6-week postoperative appointment. RESULTS: While this pilot study was not powered to determine a difference in safety or efficacy, adverse event rates were similar to the published literature. It was noted that a patient's course of therapy when utilizing apixaban was significantly less costly than warfarin when including medication, bridging, and laboratory expenses. CONCLUSION: Apixaban and warfarin both appeared to be safe and effective for anticoagulation throughout the duration of this pilot study in treating postoperative atrial fibrillation after coronary artery bypass grafting. Apixaban was associated with significantly less expense when bridging and monitoring costs were included in addition to medication expense.
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Anticoagulantes/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Puente de Arteria Coronaria/efectos adversos , Inhibidores del Factor Xa/administración & dosificación , Pirazoles/administración & dosificación , Piridonas/administración & dosificación , Warfarina/administración & dosificación , Administración Oral , Anciano , Anticoagulantes/efectos adversos , Anticoagulantes/economía , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/economía , Fibrilación Atrial/etiología , Puente de Arteria Coronaria/economía , Análisis Costo-Beneficio , Costos de los Medicamentos , Monitoreo de Drogas , Inhibidores del Factor Xa/efectos adversos , Inhibidores del Factor Xa/economía , Femenino , Humanos , Masculino , Persona de Mediana Edad , North Dakota , Proyectos Piloto , Estudios Prospectivos , Pirazoles/efectos adversos , Pirazoles/economía , Piridonas/efectos adversos , Piridonas/economía , Factores de Tiempo , Resultado del Tratamiento , Warfarina/efectos adversos , Warfarina/economíaRESUMEN
BACKGROUND: Venous thromboembolism (VTE), constituting deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common cause of vascular-related morbidity and mortality, resulting in a significant clinical and economic burden in the United States each year. Clinical guidelines recommend that patients with DVT and PE without cancer should be initiated on anticoagulation therapy with a direct oral anticoagulant over a vitamin K antagonist. Yet there is limited real-world evidence comparing the economic burden of warfarin and apixaban in treating VTE patients in a large commercially insured population. OBJECTIVE: To compare safety and effectiveness of warfarin and apixaban and evaluate associated economic burden in treating VTE patients in a large U.S. commercial health care claims database. METHODS: The PharMetrics Plus database was used to identify oral anticoagulant (OAC)-naive patients aged ≥ 18 years who initiated apixaban or warfarin within 30 days of a qualifying VTE encounter and had continuous health plan enrollment with medical and pharmacy benefits for 6 months before treatment initiation. Apixaban initiators and warfarin initiators were matched using the propensity score matching (PSM) technique. Cox proportional hazard models were used to assess and compare the risk of major bleeding (MB), clinically relevant nonmajor (CRNM) bleeding, and recurrent VTE. Generalized linear models were used to assess and compare the all-cause health care costs. A 2-part model with bootstrapping was used to evaluate MB- and recurrent VTE-related medical costs. RESULTS: Among 25,193 prematched patients, 13,421 (53.3%) were prescribed warfarin and 11,772 (46.7%) were prescribed apixaban. After 1:1 PSM, 8,858 matched warfarin-apixaban pairs were selected with a mean follow-up of 109 days and 103 days, respectively. Warfarin was associated with a significantly higher risk of MB (HR = 1.52, 95% CI = 1.14-2.04), CRNM bleeding (HR = 1.27, 95% CI = 1017.15-1.40), and recurrent VTE (HR = 1.50, 95% CI = 1.24-1.82) compared with apixaban. Warfarin patients had significantly higher all-cause medical costs per patient per month (PPPM; $2,333 vs. $1,992; P = 0.001), MB-related costs PPPM ($112 vs. $65; P = 0.020), and recurrent VTE-related costs PPPM ($287 vs. $206; P = 0.014) compared with apixaban patients. Warfarin patients had similar all-cause total health care costs PPPM ($2,630 vs. $2,420; P = 0.051) compared with apixaban patients. CONCLUSIONS: Warfarin use was associated with a higher risk of MB, CRNM bleeding, and recurrent VTE compared with apixaban. Warfarin use was also associated with higher all-cause medical costs, MB-related medical costs, and recurrent VTE-related costs PPPM compared with apixaban. DISCLOSURES: This study was funded by Bristol Myers Squibb and Pfizer, which were also involved in the study design, as well as writing and revising of the manuscript. Guo, Rajpura, Okano, and Rosenblatt are employees of Bristol Myers Squibb. Hlavacek, Mardekian, and Russ are employees of Pfizer. Keshishian, Sah, Delinger, and Mu are employees of SIMR, LLC, which received funding from the study sponsors to conduct this study.
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Costos de la Atención en Salud/tendencias , Revisión de Utilización de Seguros/economía , Revisión de Utilización de Seguros/tendencias , Pirazoles/economía , Piridonas/economía , Tromboembolia Venosa/economía , Warfarina/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes , Estudios de Cohortes , Femenino , Hemorragia/inducido químicamente , Hemorragia/economía , Hemorragia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pirazoles/efectos adversos , Pirazoles/uso terapéutico , Piridonas/efectos adversos , Piridonas/uso terapéutico , Estudios Retrospectivos , Resultado del Tratamiento , Estados Unidos/epidemiología , Tromboembolia Venosa/tratamiento farmacológico , Tromboembolia Venosa/epidemiología , Warfarina/efectos adversos , Warfarina/uso terapéutico , Adulto JovenRESUMEN
PURPOSE: Eltrombopag was evaluated as a second-line treatment for adult chronic immune thrombocytopenia (ITP) in the 2006 Phase III RAISE (Eltrombopag for Management of Chronic Immune Thrombocytopenia) randomized, placebo-controlled trial. More than 80% of patients reached satisfactory platelet counts within 2 weeks. However, the economic value of eltrombopag as a second-line treatment for ITP remains to be formally assessed. This study aimed to estimate the cost-effectiveness of treating ITP with a comparable thrombopoietin receptor agonist (eltrombopag vs romiplostim). METHODS: A Markov model was implemented over a lifetime time horizon to estimate the benefits and costs of each treatment. The model featured 3 health states based on current guidelines: (1) on treatment; (2) treatment failure/discontinuation; and (3) mortality. In line with therapeutic goals in ITP, model patients could experience 3 events: no bleeding, mild/moderate bleeding, or severe bleeding. Data on eltrombopag use were obtained from an open-label extension of previous Phase II/III trials, including RAISE. Romiplostim data were obtained from Phase III trials and an extension study. Lifetime overall survival was extrapolated by using treatment-specific mortality rates derived from severe bleeding and natural mortality rates. The costs of drugs, routine care, bleeding episodes, adverse events, and mortality were represented in the model. FINDINGS: Eltrombopag-treated patients gained 17.58 life years and 14.68 quality-adjusted life years, whereas romiplostim-treated patients gained 17.52 life years and 14.67 quality-adjusted life years. The total lifetime cost of eltrombopag treatment was estimated at $1.58 million versus $2.13 million for romiplostim. Sensitivity analyses supported base case findings. Deterministic sensitivity analysis predicted the greatest sensitivity to the rates of severe bleeding, discontinuation, and natural mortality. Probabilistic sensitivity analysis showed that eltrombopag would be an efficient use of resources at a $50,000 threshold in 52.8% of cases. In all probabilistic iterations, the total cost of eltrombopag treatment was lower than with romiplostim, primarily because of lower drug costs. IMPLICATIONS: Clinical data were applied in an economic analysis, and eltrombopag exhibited economic dominance compared with romiplostim, driven largely by the reduced costs of primary therapy. This model was limited by a lack of specific patient-level data and robust data on the duration of secondary therapy, as well as by the fact that utilization values are likely conservative estimates for routine care use.