1.1 Avatrombopag is recommended, within its marketing authorisation, as an option 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.
Why the committee made these recommendations
People with chronic liver disease may have low platelet levels. This means that they are more likely to bleed during invasive medical procedures, including surgery. Currently, they have a platelet transfusion before invasive procedures to reduce their chances of bleeding.
Avatrombopag and lusutrombopag are oral therapies that raise platelet levels to reduce the need for a platelet transfusion. Platelet transfusions rely on donors and are given intravenously, so replacing them with a treatment given by mouth is an improvement. The drugs have several other benefits, including:
fewer transfusions and a lower risk of transfusion-related complications
fewer stays in hospital.
In addition, platelets can be stored only for a short time. This may delay people getting platelets in time for their procedure. However, avatrombopag and lusutrombopag need to be taken more than a week before a procedure, so cannot be used for emergency procedures.
The economic modelling does not fully account for the benefits for patients and service delivery when using avatrombopag and lusutrombopag. It is possible that using avatrombopag would likely save the NHS money. So, avatrombopag can be recommended for treating thrombocytopenia in people with chronic liver disease who need planned invasive procedures.