OBJECTIVES: Thrombocytopenia is a common complication of chronic liver disease (CLD). When performing invasive tests and procedures in patients with CLD and insufficient platelet count, platelet transfusion (PT) is carried out to lower the risk of bleeding. In Japan, Lusutrombopag 3 mg (LUSU), an oral thrombopoietin receptor agonist, is approved to raise platelet count prior to an elective procedure and is used as an alternative to the current recommended use of PT in CLD patients. The purpose of this study was to evaluate the cost-effectiveness of this drug compared to PT in this setting from Japan.

METHODS: The cost-effectiveness of LUSU for CLD patients was evaluated using a model combining the Decision tree model during the invasive procedure and the Markov model for assessing the long-term Quality Adjusted Life Year (QALY) pay-off. The additional benefits compared to PT were quantified by a meta-analysis of two Japanese RCTs (L-PLUS1 and M0626) using random effects model. Model input parameters for Japan were collected with Targeted Literature Reviews, few parameters that could not be sourced followed the global model setting submitted to NICE in the UK. Costs were aggregated using the Japanese claims database. The cost-effectiveness of LUSU relative to PT was determined by the incremental cost effectiveness ratio (ICER) and compared to threshold of 5 million yen/QALY in Japan. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS: As a result, the base case analysis showed that LUSU was a dominant treatment option because the expected lifetime cost was cheaper by 2,689 yen compared to PT, and an additional QALY of 0.0091 was obtained.

CONCLUSIONS: Administering LUSU to lower the risk of bleeding from an invasive procedure in Japanese CLD patients is cost-saving compared to PT.