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New HTA Decisions in England
June 2020
Drug name
Doptelet® (avatrombopag)
Decision date
Therapeutic area
Liver conditions
Therapeutic sub area
Chronic liver disease
For treating severe thrombocytopenia (that is, a platelet count of below 50,000 platelets per microlitre of blood) in adults with chronic liver disease having a planned invasive procedure.
Decision Detail
The avatrombopag randomised placebo-controlled trials (ADAPT 1 and ADAPT 2) assessed 2 doses of avatrombopag: 40 mg for people with a platelet count of between 40,000 and below 50,000 platelets per microlitre of blood, and 60 mg for people with a platelet count below 40,000 platelets per microlitre of blood. The committee concluded that the trial evidence presented was appropriate for decision making. It further concluded that the evidence showed that avatrombopag reduces the number of platelet transfusions before invasive procedures in people with chronic liver disease and thrombocytopenia when compared with placebo. The committee concluded that there were no data to determine whether avatrombopag increased or decreased life expectancy compared with platelet transfusions, but that the treatment was unlikely to. The committee considered that the incremental costs for avatrombopag compared with established care modelled in the assessment group's base case may have overestimated the true costs. This was because the assessment group did not include all relevant costs. In particular, it did not include the costs of admitting patients to hospital the night before a procedure for transfusion or take into account that transfusion costs increase for patients who develop immunity. The committee agreed that the model did not take into account all the costs that might be averted. The committee agreed that benefits not captured in the quality-adjusted life year (QALY) calculation included: • lowering the risk of developing antiplatelet antibodies; • increasing the availability of platelets for emergency procedures; • providing an oral treatment rather than a transfusion. The committee agreed that avatrombopag was innovative, and took this into account in its decision making for avatrombopag. The committee concluded that the economic modelling did not fully account for the benefits for patients and service delivery when using avatrombopag. It is possible that using avatrombopag would likely save the NHS money.