Overall, these results suggest that meaningful cost savings may be achieved, in any US plan, if patients were to be treated with EPAG rather than ROMI. A sensitivity analysis found that the result was most sensitive to drug pricing and wastage inputs. Real-world studies presenting data on EPAG and ROMI average dosage in a US context were not identified; however, the dose employed in this model matches the values used in other models.9 Patients were included in the model on a prevalence basis and were assumed to have undergone an initial dose-stabilization period. Switching between thrombopoietin receptor agonists (TRAs) is a successful way to overcome adverse effects and inadequacy according to the currently available literature. This drug acquisition cost for ROMI comprised $63,179 due to drug wastage and $120,055 excluding wastage. Treating an adult using ROMI was $67,427 and $42,681 more expensive per annum than treatment with EPAG for Medicare and Medicaid plans, respectively. I was on eltrombopag and suffered from a no. -. In this article, we have tried to compare which of these two medications is the best option considering clinical effectiveness, cost-effectiveness, adverse effects, and the possibility of switching between them in case of ineffectiveness. Using this simplified tablet sizing assumption may have led to slightly overestimated EPAG costs. reticulin fibrosis in bone marrow) related to the drug as the sample size was relatively small. I think what we need to investigate is whether the bone marrow is producing enough platelets but then they get destroyed in the spleen or liver OR that not enough are being produced in the first place AND then even those few are getting destroyed or just or its just that not enough being produced. J Manag Care Spec Pharm, 2021 Oct;27(10):1447-1456. A sensitivity analysis was conducted to evaluate the robustness of the calculated cost difference to variability in model parameters (Figure 3). Base case under these inputs is $64,770. Methods: We retrospectively evaluated all adults with ITP switched from eltrombopag or romiplostim to avatrombopag at four U.S. centers from July 2019 through December 2020. Zhang J, Liang Y, Ai Y, Xie J, Li Y, Zheng W. Expert Opin Pharmacother. Under commercial pricing assumptions, EPAG was $64,770 lower in annual cost per treated patient than ROMI. 2011;117:35143520. Brand Names Nplate Generic Name Romiplostim DrugBank Accession Number DB05332 Background Five studies (510 patients) reported the proportion of patients receiving rescue treatment in TPO-RAs or placebo group [18, 20, 22, 23]. Conclusions: Data curation, This cost saving for EPAG is consistent with results reported in the Tremblay et al cost-consequence model. We administered romiplostim to Myh9/ mice (100 g/kg, every 3 days, during 1 month). Validation, In all scenarios, EPAG remained less expensive than ROMI on an annual per-patient basis. Although several medications are used for primary thrombocytopenia treatment, refractoriness remains a concern. As shown in Table 1, all studies were multicenter, double-blind, RCTs from different countries in North and South America, Asia, Europe, Africa, and Oceania. There were also. The potential cost impact decreased to $426,807 or $0.04 PMPM with Medicaid as the plan type and an assumed 10 adult patients switching from ROMI to EPAG. Eltrombopag (Epirubicin : Olamine: Hydrochloride) Emend : Empliciti : Enasidenib Mesylate: Encorafenib (Aprepitant) . Use of Eltrombopag for the First Trimester Pregnancy Complicated with Refractory Idiopathic Thrombocytopenic Purpura: A Case Report and Literature Review. and transmitted securely. PMC Plz boost yourself with positive thinkings, live on balanced diet, take sound sleep and proper rest and be careful about intracranial haemorrhage. Competing interests: The authors have declared that no competing interests exist. Eltrombopag and romiplostim might be equivalent in efficacy and safety for adult ITP, however, physicians should still take into account drug cost and comorbidities of the specific patient while making decisions on the treatment of ITP with TPO-RAs. Key model inputs including EPAG price, ROMI price, patient weight, dosing, wastage costs, administration costs, and monitoring costs were varied by plus or minus 20% to determine the sensitivity of outputs to changes in inputs. Romiplostim and eltrombopag, the first thrombopoietic receptor-agonists (TPO-RAs) with demonstrated efficacy against immune thrombocytopenia (ITP) in prospective controlled studies, were recently authorized in Europe for adults with chronic ITP. And sensitivity analysis showed that the results of PP analysis were consistent with the ITT analysis (Table 3 and Fig 3). The doctor said as soon as I stabilise at this or better I can begin to reduce the dose with the aim of coming off it completely in 3 - 6 months. 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. Careers. Accessibility FOIA Blood. Amgen Incorporated; 2019, Length of stay, hospitalization cost, and in-hospital mortality in US adult inpatients with immune thrombocytopenic purpura, 2006-2012, Cost-effectiveness of eltrombopag versus romiplostim for the treatment of chronic immune thrombocytopenia in England and Wales, Cost-consequence model comparing eltrombopag versus romiplostim for adult patients with chronic immune thrombocytopenia, Cost per response analysis of strategies for chronic immune thrombocytopenia, Integrated analysis of long term safety in patients with chronic immune thrombocytopaenia (ITP) treated with the thrombopoietin (TPO) receptor agonist romiplostim, Safety and efficacy of eltrombopag for treatment of chronic immune thrombocytopenia: results of the long-term, open-label EXTEND study, Effect of thrombopoietin receptor agonists on the apoptotic profile of platelets in patients with chronic immune thrombocytopenia, Romiplostim and eltrombopag for immune thrombocytopenia: methods for indirect comparison, Eltrombopag versus romiplostim in treatment of adult patients with immune thrombocytopenia: a systematic review incorporating an indirect-comparison meta-analysis, Therapeutic options for adult patients with previously treated immune thrombocytopenia a systematic review and network meta-analysis, Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial, Comparison of DOD, Medicaid, and Medicare part D retail reimbursement, The Medicare Part B "buy and bill" payment structure for physician-administered drugs also influences private-sector prices, Clinical policy: romiplostim (Nplate), eltrombopag (Promacta), 80076 hepatic function panel - Medicare services and charges history, How much will Medicaid physician fees for primary care rise in 2013? Three patients with AIHA and eight patients with ITP between 2008 and 2022 were enrolled in the Rheumatology Outpatient Clinic of Chang Gung Memorial Hospital, Kaohsiung. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, Corrections, Expressions of Concern, and Retractions, https://doi.org/10.1371/journal.pone.0198504, www.nice.org.uk/aboutnice/howwework/devnicetech/guidetothemethodsoftechnologyappraisal.jsp.2008. The present invention relates to compositions and methods for targeting cancer-specific DNA sequences, such as copy number amplifications and other types of cancer-specific sequen Bedruckbare dvd - Der Testsieger unseres Teams Nov/2022: Bedruckbare dvd - Ultimativer Produktratgeber Ausgezeichnete Produkte Bester Preis Alle Vergleichssieger - JETZT lesen. For a plus or minus 20% change in EPAG price, the cost difference per treated patient ranged between $40,143 and $89,397. I am considering asking my haematologist if I can switch (after being on eltrombopag for 3 months) to Romiplostim. For ROMI, dose calculations are weight-based, most likely using a fraction of the final vial, while excess remaining drug volume cannot be safely stored and reused.5 Wastage was calculated by rounding up the mean weekly dose to the nearest whole vial. This trial extended for only 2 weeks and was insufficiently powered (N = 13) to detect a significant clinical difference.12 Indirect treatment comparisons found no significant difference in safety and efficacy of the 2 drugs.13-15 Given this, assuming clinical equivalence may be a reasonable, and useful, simplifying assumption. Two trials of romiplostim and one of eltrombopag were included. Blood. Additionally, the general US payer perspective of the cost-consequence model could usefully be extended to specific Medicaid, commercial, or Medicare populations.8. official website and that any information you provide is encrypted Patwardhan was employed by Novartis Pharmaceuticals Corporation at the time of this study; Allen is an employee of Novartis. Formal analysis, Separate results were evaluated for commercial, Medicare, and Medicaid plans. are you brusing and have those little pink dots all over the arms and legs ?? I'm only on vitamin supplements. Validation, Alopecia was not one of them fortunately for me, it was mainly joint pain headaches and nausea. No, Is the Subject Area "Metaanalysis" applicable to this article? 10 k is exremely low bro !! We used a pre-designed data collection form to extract data from each eligible study. Department of Pharmacy, Guizhou Provincial Peoples Hospital, Guiyang, China, Yes Nrgaard M, Jensen A, Engebjerg MC, et al. Yes We excluded studies on patients with secondary ITP and those including both children and adults when data of adults could not be extracted separately. Unable to load your collection due to an error, Unable to load your delegates due to an error. Writing review & editing, Affiliation Data reflected that a platelet count 25 109/l at the time when the TPO-RA was initiated was associated with a 2.8 higher probability of receiving romiplostim vs. eltrombopag (P = 0.010). I'm working and moving with this count as to me "it's better to suffer from only the disease than to suffer from both disease and medications and also financially". A cost-minimization analysis, assuming equivalent safety and efficacy, found EPAG was associated with a lower net cost ($64,770 less costly using commercial plan costing) on an annual basis per adult patient than ROMI, driven by lower drug wastage and administration costs. The pooled results with a fixed-effect model (Table 3) showed that proportion of patients achieving overall response was significantly higher in the TPO-RAs group than in the placebo group (RR = 4.07, 95%CI: 2.915.70 for ELT and RR = 8.81, 95%CI: 4.0119.35 for ROM, respectively). This column reviews various issues related to preparing, disp. Average dosing for EPAG and ROMI was taken from the long-term EXTEND trial and from a published metaanalysis of 14 clinical trials, respectively. But careful monitoring is still needed during use of ROM or ELT. No, Is the Subject Area "Hemorrhage" applicable to this article? Only unique costs associated with each drug were considered. Scientific Reports - Eltrombopag versus romiplostim in treatment of children with persistent or chronic immune thrombocytopenia: a systematic review incorporating an indirect-comparison meta-analysis. Health Outcomes and Pharmacy Practice, College of Pharmacy, the University of Texas at Austin, Austin, Texas, United States, Roles These drugs help your body to make more platelets, which are cells that help your blood to clot. A targeted literature review conducted in July 2019 revealed only 1 head-to-head trial comparing the safety and efficacy of EPAG and ROMI. If more than one study reported the same outcome, the pairwise meta-analysis was conducted to calculate the pooled estimate of the risk ratio (RR) of different TPO-RAs versus placebo by RevMan 5.3. Changing the plan type from commercial to Medicaid reduced the cost difference per treated patient to $42,681 per year. Treatment efficacy for adult persistent immune thrombocytopenia: a systematic review and network meta-analysis. It was administrated at an initial dose of 1 or 3 g/kg and was also adjusted according to platelet counts (Table 1). More about Nplate (romiplostim) More about Promacta (eltrombopag) Generic Status: No lower-cost generic available. Validation, The studies used in this article were found in the PubMed database. https://doi.org/10.1371/journal.pone.0198504.g003, https://doi.org/10.1371/journal.pone.0198504.t003. Go to Top of Page Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information. An official website of the United States government. As there are clearly dose-adjustment periods for both drugs and dose-titration profiles differ between the two, these data are not fully generalizable to long-term usage and dosing. Overall, this CMA found that EPAG was substantially less expensive than ROMI in treating adult patients with cITP refractory to first-line therapies. 2013 Oct;11(5):457-69. doi: 10.1007/s40258-013-0044-y. Department of Pharmacy, Guizhou Provincial Peoples Hospital, Guiyang, China, Roles The breakdown of cost results by type in the CMA showed that drug wastage drove a substantial portion of the difference in cost between the 2 treatments. Recent evidence showed that TPO-RAs were effective and safe second-line options for primary ITP patients [7]. Disclaimer, National Library of Medicine The model was adjustable to commercial, Medicare, and Medicaid plan perspectives, with optional inclusion of drug wastage, monitoring, or administration costs. As with any economic model, the results of this CMA depend on a number of assumptions and inputs; nonetheless, the results of the sensitivity and scenario analysis indicated that the conclusions were generally robust to changes in the underlying inputs. According to a pharmacist I spoke to recently 10% of patients suffer hair loss (alopecia) on eltrombopag, and I am one of them. Romiplostim and Eltrombopag Beat Rituximab for Secondline Chronic Immune Thrombocytopenia Treatment. How TPO-RA induce these sustained responses is not known. To adjust medical procedure costs from Medicare to commercial and Medicaid plans, cost ratios were identified for Medicaid to Medicare (66%) and commercial to Medicare (128%).25,26 All prices were inflated to 2019 USD using the medical component of the Consumer Price Index.27. 2022 Feb 22;14(2):e22505. Reconstitution: 80% (v/v) ethanol for reconstitution of the . Pubmed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) published in Cochran Library were searched using the search strategies detailed in S2 Table, from their earliest records to May 2017. A cost-consequence analysis conducted in 2018 found that EPAG (tablets for oral use) was less costly than ROMI (for subcutaneous injection) on a 26-week basis in treating adult patients with cITP refractory to primary therapy. However, the value of their sequential use when no res. Federal government websites often end in .gov or .mil. No, Is the Subject Area "Idiopathic thrombocytopenic purpura" applicable to this article? 13, 14 This study evaluated the efficacy and safety of romiplostim in thrombocytopenic patients with low- or intermediate-1-risk MDS. No, Is the Subject Area "Systematic reviews" applicable to this article? Writing review & editing, Affiliation Given that the prevalence of cITP increases with age, plans with a high proportion of older patients would be expected to save more from switching treatments both as an aggregate and on a PMPM basis.2 Moreover, the apparent higher prevalence of cITP in women indicates that plans with female-skewed gender ratios would likely benefit more from such treatment switching.2 Cost savings for a Medicaid plan were somewhat lower ($426,807, $0.04 PMPM), driven by lower pricing and a lower proportion of adult patients. However, the result of indirect comparison (Fig 3) indicated that the overall response between ELT and ROM was not significantly different (RR = 0.59, 95%CI: 0.241.45). 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. As the time horizon chosen is exactly 1 year, no discounting was required. Study Design. Roles (2018) Eltrombopag versus romiplostim in treatment of adult patients with immune thrombocytopenia: A systematic review incorporating an indirect-comparison meta-analysis. Clin J Oncol Nurs. Data curation, When heterogeneity was significant (P0.1 and I250%) and could not be explained by subgroup analyses or in terms of clinical or methodological features of the trials, the random-effect model was used. Supervision, 2017 Oct;18(15):1543-1551. doi: 10.1080/14656566.2017.1373091. Investigation, and actually my count is going up at last. Romiplostim vial wastage was incorporated into the model by calculating the number of vials each patient would require on the basis of their baseline weight (the distribution of individuals' baseline weights was obtained from RAISE). ROMI is injectable, and administration costs use Medicare CPT code 96401. cThis includes liver panel monitoring only. Using WAC pricing for both treatments increased the cost difference to $74,829. Epub 2020 Aug 6. Secondary outcomes included safety, durable response, overall or clinically significant bleeding, and the proportion of patients receiving rescue medication. Thats fine so long as Im not totally bald by then. See this image and copyright information in PMC. A scenario analysis was also conducted to assess the impact of key changes to model inputs on cost difference per treated patient. EPAG was the less expensive treatment in each scenario. I see from a table showing a summary of treatments for ITP that there is a whole long list of side effects with eltrombopag but nothing significant listed at all for Romiplostim. Two frequently prescribed thrombopoietin-receptor agonists, eltrombopag (EPAG) and romiplostim (ROMI), have not been compared in head-to-head trials for the treatment of chronic immune thrombocytopenia (cITP); however, they are generally accepted as therapeutic alternatives with comparable safety and efficacy. The cost difference per treated patient was calculated as the difference in unique costs between the 2 therapies. Kazpig1 thanks for your comment. This patient total was used to calculate the potential cost impact of switching all adult patients in a hypothetical plan taking ROMI to EPAG. All studies [1623] had low risk of performance bias and detection bias, as both patients and study personnel were masked. METHODS: A cost-minimization model was developed in Microsoft Excel. This site needs JavaScript to work properly. The first of these agents to receive regulatory approval, romiplostim and eltrombopag, have demonstrated impressive efficacy and tolerability in randomized controlled trials and open-label extension studies of several years duration and stand poised to . Mean dosing inputs per patient were obtained from largest available long-term trial dosing data. All patients were aged 18 years old, with disease duration more than 3 months and baseline platelet count less than 30109/L. EPAG mean dose (in mg) was obtained from the extension period of the pivotal clinical trial (EXTEND), and ROMI mean dose (in g/kg) came from a published meta-analysis of 14 clinical trials.10,11 A meta-analysis was identified for primarily long-term use for ROMI, but not for EPAG. EPAG was also found to be meaningfully cheaper than ROMI in a UK-based cost-effectiveness analysis, and a recent US-based cost-effectiveness analysis, which reported a base-case lifetime cost difference of $545,562, with similar efficacy.7 A US-based 2018 cost-per-response model using short-term trial inputs found that EPAG had a higher incremental cost per additional responder, but lower incremental costs than ROMI (EPAG: $31,922 vs ROMI: $33,815, 2015 USD).9 The consistent finding of lower costs associated with EPAG across several model types and regions supports the finding that EPAG is indeed the lower cost treatment for cITP. Welche Kauffaktoren es bei dem Kaufen die Kuechenblock zu beurteilen gilt Unsere Bestenliste Nov/2022 Umfangreicher Produktratgeber TOP Geheimtipps Beste Angebote Smtliche Testsieger - Jetzt direkt vergleichen. As dose changes are titrated in 25 mg intervals, the model assumed 25 mg is the most common tablet size used. Funding: The authors received no specific funding for this work. We only included RCTs in this review, the results might not have good generalizability for strict inclusion criteria and small sample size in those studies. . Ten databases were searched during 2010. Conceptualization, Moreover, a disproportionality analysis in the World Health Organization global individual case safety report (ICSR) database (VigiBase) suggested the presence of a signal for an increased risk of thrombosis with ELT compared to ROM (adjusted reporting odds ratio = 1.72, 95%CI 1.472.02) [30]. analyzed the cost between patients treated with romiplostim and eltrombopag in England and Wales and concluded that eltrombopag is cost-effective compared to romiplostim. PMC Another noteworthy limitation with the application of this model is that it did not account for the substantial cost due to variances in billing/reimbursement rates that may often exist on the medical benefit for ROMI in commercial lines of business. However, as demonstrated in the scenario analysis, even under the very conservative assumption of no ROMI wastage, EPAG was still the less expensive treatment. Used to treat thrombocytopenia associated with chronic immune thrombocytopenia (ITP). Project administration, ics are currently approved in the US and Europe: romiplostim and eltrombopag. Change in mean dosing had the same sensitivity as drug price for each treatment, and weight has the same variability as ROMI pricing. To date, two TPO-R agonists, romiplostim and eltrombopag, have been approved by the FDA for the treatment of ITP in humans. Response to Treatment With Eltrombopag, MeSH The thrombopoietic growth factors (TGFs) are a novel class of compounds for the treatment of chronic immune thrombocytopenia (ITP). Proudman, Lucas, and Nellesen are employees of Analysis Group, Inc., which received funding from Novartis Pharmaceuticals Corporation to conduct this study. The prevalence of cITP in adults was based on a 2008 US claims analysis in which separate rates were reported for adults aged older and younger than 65 years.2 The overall prevalence rate in the model was calculated based on the proportion of patients aged older and younger than 65 years in the plan type.29,30 The proportion of patients refractory to primary therapy was based on a 2010 review of studies on sustained response rates (SR) for dexamethasone (median SR 67.6% over 2-5 years) and methylprednisolone (23% at 39 months),31-35 using the mean of these 2 figures (45.3%). The total administration cost for EPAG was $0 and for ROMI was $5,377 per year. vs. 85 [63-100], p = 0.17). Eltrombopag and its beneficial role in management of ulcerative Colitis associated with ITP as an upfront therapy case report. TABLE 1 Cost Difference per Treated Patient and Potential Cost Impact, Commercial Plan Perspective. ambient light vs amber IV bag covers to limit UV exposure. 8600 Rockville Pike https://doi.org/10.1371/journal.pone.0198504.g002. Results: Hi I have had both of these drugs and suffered from side effects with both. Cost effectiveness of romiplostim for the treatment of chronic immune thrombocytopenia in Ireland. Eltrombopag was given for a median of 91 days (8-206) and at a median dose of 100. ROMIs annual administration cost, calculated at $5,377 per patient, was also an element of the higher total cost for ROMI. Although several medications are used for primary thrombocytopenia treatment, refractoriness remains a concern. 2018 Nov;22(11):5367-5377. doi: 10.1111/jcmm.13809. American Society of Hematology 2019 guidelines for immune thrombocytopenia. The https:// ensures that you are connecting to the Eltrombopag: 3: Romiplostim: 4: Sirolimus: 1 (4) Combined treatment a 1 (4) Number of previous treatment lines (%) . Thrombopoietin Receptor Agonists in the Treatment of Chronic Resistant Primary Immune Thrombocytopenia: Efficacy and Safety Data in Real Clinical Practice. So far, no data are available on the potential contribution of switching from ROM to EPAG or vice versa in terms of efficacy or . Two authors independently assessed the risk of bias of each included study using the checklist developed by Cochrane Collaboration [13]. The sensitivity of the cost difference per treated patient was assessed by conducting a deterministic 1-way sensitivity analysis. Clin Case Rep. 2021 Jan 21;9(3):1416-1419. doi: 10.1002/ccr3.3783. DISCLOSURES: This study was funded by Novartis Pharmaceuticals Corporation. After frontline treatment with corticosteroids fails to elicit a response in patients with chronic immune thrombocytopenia (cITP), the choice between rituximab or thrombopoietin receptor agonists (TPO-RAs) is unclear. Aggregating drug acquisition, administration, and monitoring costs yielded an estimate that in a commercial plan, treating an adult patient using ROMI was $64,770 more expensive per year than treatment with EPAG. It has been a whirl wind. mycophenolate and eltrombopag ( as neither worked just by themselves) has anyone else with ITP had anyone had or tried eltrombopag or romiplostim. 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In treating adult patients in a fluid state still needed during use ROM Considering all studies [ 1623 ] had low risk of performance bias and detection,, P = 0.17 ) Collaboration [ 13 ] nrgaard M, D. About PLOS Subject Areas, click here promises fair, rigorous peer review, broad scope, and plans
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