Economic assessment of eltrombopag in the treatment of thrombocytopenia

Abstract

Objective: This study assesses the cost–effectiveness of eltrombopag in the treatment of hepatitis C virus (HCV)-related thrombocytopenia. Methods: A Markov model was constructed on the basis of the clinical trials ENABLE 1 and ENABLE 2. Three alternatives were considered: scenario 1; treatment with eltrombopag in both the enabling phase and during antiviral therapy, as in the ENABLE trial design; scenario 2; no eltrombopag treatment and no antiviral therapy; scenario 3; no eltrombopag treatment and subsequent administration of a reduced dose of peg-IFN. Results: Base case results demonstrate that scenario 1 is associated with a cost per QALY of €30,020.94 in comparison with scenario 2. The incremental cost–effectiveness ratio reaches a value of €32,752.44 per QALY when scenario 1 is compared with scenario 3. Conclusion: The use of eltrombopag in HCV patients with thrombocytopenia is cost-effective as it leads to a reduction in disease progression and thus a drop in the number of patients with advanced liver disease.

Keywords:

• cost–effectiveness
• Markov model
• revolade
• sensitivity analysis
• thrombocytopenia

Financial & competing interests disclosure

This study was funded by GlaxoSmithKline (Brentford, UK). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Thrombocytopenia is one of the most common complications of HCV and an obstacle to possible treatment with antiviral therapy. The available evidence demonstrates that eltrombopag, an oral thrombopoietin agonist, produces an increased platelet count in antiviral therapy candidate thrombocytopenic patients, allowing an increase in the sustained virologic response.

• The cost–effectiveness of eltrombopag in HCV patients were explored through a Markov model.

• Results of this economic assessment showed that the use of eltrombopag in both the initial and maintenance phase has a favorable cost–effectiveness ratio in comparison with the alternative scenarios that do not involve eltrombopag treatment.

• Further research should explore the cost–effectiveness of eltrombopag in sofosbuvir candidate patients.