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

Figures & data

Table 1.  Resources assumed in calculating the costs of drug acquisition, preparation, and administration of romiplostim and IVIg, and patient follow-up monitoring.

	Romiplostim	IVIg
Drug acquisition resources
Usual dose	Initial dose: 1 μg/kg SC once weekly adjusted by increments of 1 μg/kg to achieve and maintain a platelet count ≥50 × 10^9/L Median dose: 3 μg/kg/week	Initial dose: 1 g/kg IV per patient per day for 2 days^a Maintenance dose 0.62 g/kg IV every 2.6 weeks^b
Dose per 70 kg person	210 μg weekly	140 g for first 2 days then 43.3 g per infusion provided every 2.6 weeks^b
Wholesaler mark-up	$39.00^c	Not applicable
Dispensing fees	13 scripts per year	Not applicable
Resources consumed in the preparation and administration of romiplostim and IVIg
Clinical nursing time	6.93 h to complete 52 injections per year^d Each injection requires a total of 8 min (5 min for reconstitution + 3 min for SC injection)	17.98 h to complete 21.6 infusions of IVIg^e Each infusion requires a total of 29.94 min (includes review patient files, IV set-up and disconnection, pump set-up, and for four vital sign measurements)
Laboratory technician time	Not applicable	3.6 h for 21.6 infusions^e Each infusion requires a total of 10 min to register IVIg product in patient files, review prescription, and label product
Assistant technician time	Not applicable	5.4 h for 21.6 infusions^e Each infusion requires a total of 15 min for script requisition, drug distribution to infusion clinic and patient appointment follow-up
Medical supplies for drug administration	52 of each: • Sterile water for dilution (10 mL) • Syringes 1 ml 25G × 5/8	21.6 ^e of each: • Primary IV lines • 250 ml dextrose 5% • Tubing with 15 μg filter • Gelco BDInsyte 22Ga (0.9 × 25 mm) • BD Lever lock cannulas
Follow-up monitoring resources
Auxiliary nursing time	88 min 8 min to draw blood each time^f	88 min 8 min to draw blood each time^f
Laboratory tests	CBC, platelets, peripheral blood smear	CBC, platelets, peripheral blood smear
Medical supplies for blood tests	11 of each^f: • Venous collection tubes • Haematology tubes • Syringes hypo 10–12 ml	11 of each^f: • Venous collection tubes • Haematology tubes • Syringes hypo 10–12 ml

^aBased on international consensus6.

^bBased on data collected from the participating hospitals in Québec.

^cBased on a maximum mark-up of $39.00 per vial for products over $600.00 per unit in 2012.

^dRomiplostim injections were provided in the hospital outpatient setting. Although some patients may self-inject romiplostim, self-administration is not an approved dosing method in Canada.

^eTwo infusions were required to initiate treatment and 19.6 infusions were required for maintenance (calculated as 52 weeks − 1 initial week = 51 weeks divided by average 2.6 week infusion frequency as reported at the participating hospitals).

^fAt baseline and weekly for weeks 1–4 then every 8 weeks thereafter.

Table 2.  Lost productivity associated with treatment of ITP with romiplostim or IVIg.

	Romiplostim	IVIg
Patient time away from work	11.27 h total for 52 visits • 8 min injection time • 5 min waiting time	91.8 h total for 21.6 infusions • 15 min waiting time • 30 min to set up IV line for infusion • 210 min for IVIg administration

Table 3.  Unit costs.

Resource	Unit cost ($CAD)	Data source
Romiplostim cost per 250 μg vial	$882.50	Amgen Canada
IVIg cost/g	$100.00	Canadian Blood Services
Dispensing fee per prescription (romiplostim only)	$8.17	Régie de l’assurance maladie du Québec (RAMQ) formulary^a
Wholesaler mark-up per vial(romiplostim only)	$39.00	RAMQ formulary^a
Clinical nurse hourly wage	$35.15	Comité patronal de négociation du secteur de la santé et des services sociaux, April 2012 (CPNSSS)
Laboratory technician hourly wage	$29.63	CPNSSS
Assistant technician hourly wage	$21.53	CPNSSS
Sterile water (10 mL)	$0.02	Buying group in Québec^b
Primary IV lines	$10.99	Buying group in Québec^b
Dextrose 5% (250 mL)	$1.10	Buying group in Québec^b
Gelco BDInsyte 22 Ga	$1.24	Buying group in Québec^b
BD Lever lock cannulas	$0.46	Buying group in Québec^b
Tubing with 15 μg filter	$4.25	Buying group in Québec^b
CBC, platelets, blood smear	$6.00	Ministère de la santé et des services sociaux du Québec (2011/12)
Venous blood collection tube	$0.13	Buying group in Québec^b
Haematology collection tube	$0.11	Buying group in Québec^b
Syringes hypo (10–12 ml)	$0.10	Buying group in Québec^b
Average hourly Québec wage for employees ≥25 years of age	$22.72	Statistics Canada (2010/11)

^a2010 Pharmacists’ fees, 2012 wholesaler mark-up.

^bCosts obtained as of November 2011.

Table 4.  Comparative total costs ($CAD) of managing ITP patients with romiplostim vs IVIg.

Cost category	Romiplostim	IVIg
Drug acquisition	$48,024	$98,868
Medication preparation and administration	$309	$1245
Patient monitoring	$121	$121
Lost productivity	$256	$2086
Total	$48,710	$102,320

Table 5.  Incremental cost with IVIg under various sensitivity scenarios ($CAD).

	Romiplostim	IVIg	Incremental cost of IVIg
Base case:Romiplostim 250 μg/week and IVIg dose 0.62 g/kg with 3.5 h infusion	$48,710	$102,320	$53,610
Higher romiplostim dose (500 μg/week)	$91,071	$102,320	$11,249
Lower IVIg dose (0.3 g/kg)	$48,710	$58,612	$9902
Higher romiplostim dose (500 μg/week) and lower IVIg dose (0.3 g/kg)	$91,071	$58,612	−$32,459*
Higher IVIg dose (0.8 g/kg)	$48,710	$130,936	$82,226
Shorter IVIg infusion time (2.5 h)	$48,710	$101,765	$53,055
Longer IVIg infusion time (5 h)	$48,710	$103,119	$54,409
Lower IVIg maintenance dosing frequency (12.4 doses/year)	$48,710	$71,144	$22,434
Higher IVIg maintenance dosing frequency (42.5 doses/year)	$48,710	$201,477	$152,767

*IVIg was cost-saving in this scenario.

Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010;115:168-86

 PubMed Web of Science ®Google Scholar