OBJECTIVES TPO-RAs, represent an evidence-based treatment option in the public setting for adult patients with chronic ITP in Mexico. TPO-RAs have not been directly compared in head-to-head randomized controlled trials (RCTs); however an indirect comparison was undertaken using Bayesian metaregression: the overall platelet response was significantly higher in patients receiving Romiplostim than in those receiving Eltrombopag, estimating an Odds ratio (OR) of eltrombopag vs romiplostim as 0.15 (95% CI: 0.02, 0.84). The objective of this study is to compare the cost per response of TPO-RAs in chronic adult ITP in Mexico. METHODS A cost per response analysis was developed. Dose was derived from RCTs and Summary of Product Characteristics. Median dose for romiplostim was 2.5 mcg/kg/week and average dose for eltrombopag was 55 mg/day (21.5% of patients received 25mg; 41% 75mg; and remaining 37.5% 50mg). Costs for romiplostim were based on vials used, considering a representative Mexican patient (65kg); for eltrombopag, it was based on milligrams needed. Cost assessment included cost of medication, cost of administration and in case of eltrombopag, cost of liver monitoring, expressed in Mexican pesos. Crude Overall Response Rate (ORR) for romiplostim  was 83%. Placebo adjusted ORR for eltrombopag was 42% calculated by applying the OR estimated from the Bayesian indirect comparison performed by the NICE Evidence Review Group. RESULTS Romiplostim generates a cost per overall platelet response of $219,690.80, while eltrombopag yields $374,137.72. CONCLUSIONS Within the TPO-RAs, romiplostim generates a lower cost per response than eltrombopag, in adult patients with chronic ITP in Mexico.