Cost- Effectiveness of Avatrombopag for the Treatment of Thrombocytopenia in Patients with Chronic Liver Disease

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.

Keywords:

• liver diseases platelet transfusion
• thrombocytopenia
• cost-effectiveness

Abbreviations

CLD, Chronic liver disease; ICER, Incremental cost-effectiveness ratio; US, United States; VTE, venous thromboembolism.

Acknowledgments

The authors thank Brian Samsell and Kate Lothman of RTI Health Solutions for providing medical writing assistance. The abstract of this paper was presented at the 62^nd American Society of Hematology (ASH) Annual Meeting and Exposition as a poster presentation with interim findings. The poster’s abstract was published as a supplement in Blood: https://doi.org/10.1182/blood-2019-131822.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

DM and CB are employees of RTI Health Solutions, Research Triangle Park, NC, USA, which received funding under a research contract with Dova Pharmaceuticals, Durham, NC, USA, to conduct this study. MV is an employee of Dova Pharmaceuticals. KA was an employee of Dova Pharmaceuticals during the study period. RK has received honoraria for consulting and participating in advisory boards for Dova. DD has received honoraria for participating in advisory boards for Dova. All relevant conflict of interests have been reported for each author. The authors report no other conflicts of interest in this work.

Additional information

Funding

RTI Health Solutions (Research Triangle Park, NC, USA), an independent nonprofit research organization that does work for government agencies and pharmaceutical companies, received funding under a research contract with Dova Pharmaceuticals (Durham, NC, USA) to conduct this study and provide editorial support in the form of manuscript writing, styling, and submission.