OBJECTIVES: This study’s objective was to develop a Cost-Consequence Model comparing eltrombopag versus romiplostim for adult patients with Chronic Immune Thrombocytopenia (cITP) in the US. METHODS: A cost-consequence model was developed using a decision tree approach to evaluate the costs relative to treatment success of eltrombopag (ELT), romiplastim (ROM), and watch and rescue (W&R) in previously treated patients. Data on platelet count response rate, bleeding events, and adverse events were derived from all identified phase III registered clinical trials. Since none of the included treatments were compared in head-to-head trials, health outcomes were compared via indirect treatment comparison. Costs incorporated in the model included drug and administration, routine care, rescue medication, bleeding-related adverse event, other adverse event and mortality costs. RESULTS: In the ITT population, overall estimated cost per patient for eltrombopag was $66,560, compared with $92,631 for romiplostim and $30,099 for W&R. Compared with the ITT population, this difference in cost between ELT and ROM was greater in splenectomised patients and slightly less in non-splenectomised patients, though the overall trend remained the same. When assessing cost per severe bleeding avoided in the ITT population, ELT dominated (was less expensive and more effective than) ROM. Regarding costs per responder, ROM showed an incremental benefit over ELT of 23.1%, yielding an ICER of $113,055. Sensitivity analysis results were also consistent with the basecase findings, with results most sensitive to variations in platelet response and changes in primary therapy prices. CONCLUSIONS: TPO‐R agonists (including eltrombopag and romiplostim) are favourable options for the treatment of adults with chronic ITP who have had an insufficient response to corticosteroids or immunoglobulins. Eltrombopag was shown to be a relatively efficient use of resources to treat chronic immune thrombocytopenia when indirectly compared to romiplostim, largely driven by its favorable severe bleeding outcomes.