Cost comparison study of adding eltrombopagin combined with immunosuppressive therapy to treat severe aplastic anemia in first line setting at Khon Kaen Hospital from 2018-2020

Abstract

Objective: Severe Aplastic Anemia (SAA) has a major impact on healthcare, affecting individuals at both clinical and health economic levels. Antithymocyte globulin (ATG) and cyclosporin A (CSA) are the most common treatments in first line setting. Using eltrombopag combined with ATG+CSA for six months increased patient overall response rate. To explore the potential impact of SAA prescribing patterns on healthcare costs in real life, this study analyzed the costs of adding eltrombopag combined with ATG+CSA compared with ATG+CSA by considering health outcomes and AE management. Materials and methods: A cost comparison model was developed using a 6-month response rate as the outcome input (94.0 vs. 17.4%). Direct medical and nonmedical costs of one-year care per patient were collected retrospectively from Khon Kaen Hospital from 2018-2020 and categorized as either responsive or nonresponsive to compare the costs between with and without eltrombopag in treatment using a patient perspective. Results: Data of 20 patients with SAA were included in the evaluation with 12 responsive and 8 nonresponsive. The total drug cost of ATG+CSA was estimated at 691,354 THB. Eltrombopag costs added 358,621 THB. The total direct healthcare-related costs were estimated at 193,531 THB/year and 502,567 THB/year in responsive and nonresponsive groups, respectively. The average savings regarding direct medical and nonmedical cost was then estimated at 151,657 THB/patient/year for eltrombopag+ATG+CSA. Conclusion: Considering both relevant health outcomes and AE management, adding eltrombopag combined ATG+CSA showed a saving in overall costs/year to patients. To reduce the burden of SAA conditions, eltrombopag should be regarded as a priority to treat SAA as first line.