OBJECTIVES:: Romiplostim and eltrombopag are both indicated for the treatment of chronic immune thrombocytopenia (ITP) in splenectomized who are refractory to conventional treatments and rescue therapies, and in non-splenectomized where surgery is contra-indicated. The aim of this analysis was to assess the expected costs and outcomes with both therapies for the treatment of chronic ITP from the perspective of the public health system in Mexico. METHODS::  A decision tree model was developed simulating the pathway of splenectomized and non-splenectomised patients with romiplostim or eltrombopag over a time horizon of 24 weeks. The effectiveness was measured by the overall platelet response (OPR) rate (at least 4 weeks with platelet response). The efficacy estimates for eltrombopag were obtained using an adjusted indirect treatment comparison. Only direct medical costs were considered, including drug acquisition, drug administration, laboratory tests, medical visits, and bleeding related events. Sensitivity analysis was conducted to evaluate robustness of the results. All costs were expressed in 2016 US dollars. RESULTS::  The proportion of patients achieving OPR was higher with romiplostim (79.6%) than with eltrombopag (37.4%). The cost per treated patient was 30% lower with romiplostim than eltrombopag ($15,860 Vs. $23,212), driven mainly by cost-savings in the bleeding related costs with romiplostim (-50%). The average cost per patient achieving OPR was also lower with romiplostim vs. eltrombopag ($19,916 Vs. $62,107). The results were consistent and robust to variations in the main inputs. CONCLUSIONS:: The results of this analysis suggest that romiplostim is a dominant treatment strategy vs. eltrombopag in patients with chronic ITP, as it is associated with more than twice as many patients achieving OPR as well as with cost-savings vs. eltrombopag in the bleeding related events, especially in those events requiring rescue therapy with immunoglobulin. Romiplostim is expected to result in significant savings for the healthcare institutions in Mexico.