Clinical Impact of Aprepitant in Patients Receiving High-Dose Chemotherapy prior to Autologous Peripheral Blood Stem Cell Transplantation: A Cost-Effectiveness Analysis

Abstract

Objective: To evaluate the clinical and cost benefits of the administration of aprepitant for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV) during high-dose chemotherapy (HDCT). Methods: We retrospectively reviewed the charts of patients who received HDCT at our institution between January 2009 and December 2013. Cost-effectiveness was analyzed using direct medical costs. Results: We identified a total of 38 patients (27 with non-Hodgkin lymphoma and 11 with multiple myeloma). Thirteen patients received aprepitant and granisetron (aprepitant group) for CINV prophylaxis, whereas 25 patients received granisetron only (non-aprepitant group). The incidence of severe nausea (≥grade 3) was significantly lower in the aprepitant group than in the non-aprepitant group (p = 0.039). The total mean cost per patient during hospitalization, excluding the cost of HDCT and transplantation, was USD 10,941.8 in the aprepitant group and USD 14,577.2 in the non-aprepitant group (p = 0.041). This cost benefit reflected reductions in the costs of hospitalization, transfusion, and infection treatment. Conclusions: Our data indicated that the addition of aprepitant for CINV prophylaxis during HDCT reduced the incidence of severe nausea and might also provide economic benefit in the overall management of HDCT prior to autologous peripheral blood stem cell transplantation.

Cost-Effectiveness of Aprepitant in Preventing Chemotherapy-Induced Nausea and Vomiting: A Systematic Review of Published Articles

“…The clinical data of Chanthawong et al ( 22 ) and Cawston et al ( 20 ) came from systematic review and metaanalysis. Nakamura et al ( 27 ) acquired data from a retrospective analysis of direct medical costs of National Hospital Organization Nagoya Medical Center between January 2009 and December 2013.…”

“…Of the 13 studies included, eight of used the decision analytical model ( 18 , 21 – 25 , 28 , 30 ), four used the Markov model ( 19 , 20 , 26 , 29 ), and one study did not use model analysis ( 27 ).…”

“…In contrast, one study used a patient and statutory health insurance perspective ( 25 ), and two studies used the perspective of the payer, but did not describe it specifically ( 19 , 26 ). One study used a societal perspective ( 22 ) and one study ( 27 ) did not mention it.…”

“…The time horizon for two studies ( 18 , 19 ) was four cycles (21 days in each cycle), for another eight studies ( 20 – 25 , 28 , 30 ) time horizon was 5 days, for one study ( 26 ) it was five cycles (28 days in each cycle), time horizon of one study ( 29 ) was at least six cycles (5 days in each cycle) when CUA was conducted and 5 years when budget impacted analyses, and one study ( 27 ) did not mention the time horizon.…”

“…Among the included studies, the most common comparison was the aprepitant triple regimen (aprepitant+5-HT3RA+glucocorticoid) vs. standard regimen (5-HT3RA+glucocorticoid) with or without placebo ( 18 , 19 , 21 , 24 – 26 , 28 , 30 ), the other comparison was aprepitant +5HT3RA vs. aprepitant ( 27 ), and the comparison of positive comparators such as netupitan + palonosetron (PAL) (NEPA) ( 20 , 29 ), metoclopramide ( 23 ), and olanzapine ( 22 ). Most studies reported ICERs as cost-effectiveness evaluation outcomes.…”