OBJECTIVES: To assess the cost-effectiveness of romiplostim in the treatment of adult patients with ITP in the Czech Republic, in comparison with the medical standard of care (SoC) and eltrombopag. METHODS: A lifetime treatment sequence cost-utility Markov model was developed from the health care payer perspective. The model was based on the treatment sequences that reflect current practice for ITP management and was driven by platelet response (platelet count ≥50x10/L), which determined effectiveness and progression along the treatment pathway, need for rescue therapy and risk of bleeding. Costs were derived from reimbursement lists available in January 2013. Four scenarios were conducted where romiplostim was compared with SoC with rituximab, SoC without rituximab, SoC without both rituximab and mycophenolate mofetil (MMF), and eltrombopag. Patients were evaluated by splenectomy status and for the combined population (CP). RESULTS: Compared to SoC with rituximab, romiplostim was dominant in splenectomised patients and CP, with cost savings of 2,203,982CZK and 1,078,899CZK and gains of 1.58 and 1.81 quality-adjusted life-years (QALYs), respectively, and was cost-effective in non-splenectomised patients with an ICER of 44,107 CZK/QALY. Compared to eltrombopag, romiplostim was dominant in splenectomised patients and CP, with cost savings of 1,626,409CZK and 741,613CZK and gains of 1.12 and 1.21 QALYs, respectively, and was cost-effective in non-splenectomised patients with an ICER of 74,266 CZK/QALY.Similar results were shown in the other two scenarios: romiplostim was dominant in splenectomised patients and CP compared to SoC without rituximab and SoC without both rituximab and MMF, and was cost-effective in non-splenectomised patients with ICERs of 51,011CZK/QALY (SoC without rituximab) and 41,192CZK/QALY (SoC without rituximab and MMF). CONCLUSIONS: Romiplostim was less costly with higher QALY gain compared to SoC and eltrombopag in splenectomised patients and CP. Romiplostim was cost-effective with ICERs between 41,000 and 74,000CZK/QALY in all non-splenectomised populations in all four scenarios.