OBJECTIVES: ITP, an autoimmune disorder characterized by isolated thrombocytopenia, puts patients at risk of BRE, the management of which can pose a high economic burden. The novel TPO-mimetic romiplostim is recommended for treatment of adult patients with chronic ITP. We compared BRE rates, and the costs of managing BRE in Mexico, for romiplostim vs. SOC in adult patients with chronic ITP. METHODS: BRE rates were obtained from two randomized placebo-controlled trials in splenectomized and non-splenectomized patients. BRE were categorized as: outpatient minor bleed, bleed requiring immunoglobulin treatment, or bleeding-related hospitalizations. BRE costs were calculated by splenectomy status and treatment group, with unit costs obtained from the 2010 Official Price List of the Public Healthcare System in Mexico. The frequency of each BRE was multiplied by its managing cost and this total cost divided by the total number of patient-weeks in each treatment arm to obtain an average cost per patient per week. The average cost per patient per week was then extrapolated to the treatment duration of 52 weeks. RESULTS: The analysis included 62 non-splenectomized (41 romiplostim, 21 SOC) and 63 splenectomized patients (42 romiplostim, 21 SOC), with a total of 2,715 patient-weeks on study. Romiplostim yielded a 55% reduction in all BRE (95% CI:  41% to 65%) and an 88% (95% CI 80% to 93%) reduction in those requiring immunoglobulin treatment. The estimated yearly BRE management cost per non-splenectomized patient was MXP$33,103 for romiplostim and MXP$162,720 for SOC. The estimated yearly BRE management cost per splenectomized patient was MXP$31,328 for romiplostim and MXP$283,246 for SOC. CONCLUSIONS: Romiplostim is an important therapeutic alternative for adult patients with chronic ITP which reduces the incidence of BREs compared to SOC, and lowers BRE management costs for the Mexican Public Healthcare system.