NICE has issued an Appraisal Consultation Document stating that romiplostim is not recommended for the treatment of chronic idiopathic (immune) thrombocytopenic purpura, as it was not a cost-effective use of NHS resources. The Appraisal Committee considered that although there are reasons to suggest that romiplostim may confer clinical benefits over other active treatments, evidence for its relative effectiveness compared with other active treatments is lacking. The closing date for comments is 26th November 2009 and the second Appraisal Committee meeting will take place on 7th January 2010.