Comparative net cost impact of the utilization of romiplostim and intravenous immunoglobulin for the treatment of patients with immune thrombocytopenia in Québec, Canada

Abstract

Objectives:

Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by platelet destruction, sub-optimal platelet production, and mild-to-severe bleeding. Nplate® (romiplostim), a thrombopoietin receptor agonist, and intravenous immunoglobulin (IVIg), an expensive and occasionally scarce blood product, are used in the treatment of ITP. The objective of this study was to compare the total cost of treating patients with romiplostim vs IVIg in Québec, Canada.

Methods:

A net cost impact model was developed to calculate the annual cost of romiplostim compared with IVIg based on actual practice observations in all patients (n = 95) treated for chronic ITP with IVIg from April 2010 to March 2011 in two participating hospitals. The model included costs of: drug acquisition, drug preparation and administration, patient monitoring, and indirect costs. Healthcare practitioners were consulted regarding romiplostim and IVIg treatment algorithms and the resources involved in patient monitoring.

Results:

The average annual drug acquisition costs of romiplostim and IVIg were $48,024 and $98,868, respectively. Lower costs for drug preparation and administration ($309 vs $1245) and less time lost from work ($256 vs $2086) were attributed to romiplostim. The cost of follow-up monitoring was the same for both romiplostim and IVIg ($121). The total average annual per patient costs for romiplostim vs IVIg were, respectively, $48,710 and $102,320. The use of romiplostim was projected to save, on average, almost $54,000 per patient per year.

Limitations:

The study was conducted in two hospitals in Québec. Romiplostim may show different cost savings in other hospitals and other provincial and national jurisdictions.

Conclusions:

Scarce blood products must be used wisely. Romiplostim can allow for improved healthcare resource allocation by reserving IVIg for use in other areas of greater need while also providing cost savings for the overall provincial healthcare budget.

Keywords::

• Romiplostim
• Immune thrombocytopenia
• ITP
• Net cost impact
• Reimbursement

Transparency

Declaration of funding

The study was funded by Amgen Canada Inc. Approval and preparation of the manuscript for publication was not dependent upon approval of the sponsor.

Declaration of financial/other relationships

JK and VL have participated in Amgen advisory board meetings. MP has completed work for Amgen on a consulting basis. RD is an employee of Amgen Inc. and KG is an employee of Amgen Canada Inc.

Acknowledgements

The authors would like to thank the following individuals that assisted with the development of this study and manuscript: Ms Lindy Forte for medical writing assistance; Amgen Canada for providing funding for the medical writing assistance; M. Dominic Mitchell, Part Owner and Principal Consultant of IMAC Canada; Mme Claudette Charette, assistante infirmière chef, département d’hémato-oncologie, Centre hospitalier de l’Enfant-Jésus, Mme Mélanie Grenier, infirmière clinicienne, Chargée de sécurité transfusionnelle, Hôpital Maisonneuve-Rosemont, and Mme Kathy Pelletier, infirmière clinicienne, Chargée de sécurité transfusionnelle, Hôpital Maisonneuve-Rosemont.