Cost‐effectiveness analysis of aprepitant‐based anti‐emetic regimen for children receiving highly emetogenic chemotherapy: Individual patient data analysis of a randomized trial

Singh, Manraj; Ganguly, Shuvadeep; Sasi, Archana; Sharma, Priya; Giri, Rupak Kumar; Rasheed, Azgar Abdul; Bakhshi, Sameer

doi:10.1002/pbc.29795

Cited by 3 publications

(5 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A survey done at our institute showed that caregivers of children receiving HEC are willing to pay US$703.62±US$526.15 (mean±SE) for prophylactic antiemetics and management of any breakthrough vomiting 13. Hence, based on the ICER estimates of our analysis, caregivers in India would be willing to pay for the additional cost conferred by the addition of olanzapine for improving the control of CINV.…”

Section: Discussionmentioning

confidence: 95%

“…The cost of hospitalisation incurred due to grade ≥3 vomiting is a large contributor to the overall expenditure. In our previous work, we have shown that the addition of aprepitant to ondansetron and dexamethasone leads to cost savings which are primarily driven by the prevention of grade ≥ 3 vomiting 13. A cost-effectiveness analysis of olanzapine containing antiemetic regimens in adults in Southeast Asia showed that regimens consisting of four drugs including dexamethasone, 5-HT3RA, aprepitant and olanzapine were less cost-effective as compared with regimens containing dexamethasone, 5-HT3RA and olanzapine 11.…”

Section: Discussionmentioning

confidence: 99%

“…The methodology used for cost-effectiveness analysis in this study is similar to our previous work evaluating the cost-effectiveness of aprepitant for children receiving HEC 13…”

Section: Methodsmentioning

confidence: 99%

“…Olanzapine-based antiemetic regimens in adults have been shown to be cost-effective in the USA and Southeast Asia 11 12. Previously, we have shown that the addition of aprepitant to ondansetron and dexamethasone results in cost savings for children receiving HEC in India, the UK and the USA 13. However, the cost-effectiveness of the addition of olanzapine as a fourth agent to the standard three-drug antiemetic regimen is unknown in the paediatric population.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Olanzapine cost-effectiveness in vomiting and nausea from highly emetogenic chemotherapy in children and adolescents

Singh

Ganguly

Naik

et al. 2023

BMJ Support Palliat Care

Self Cite

View full text Add to dashboard Cite

ObjectivesTo assess the cost-effectiveness of addition of olanzapine to a prophylactic antiemetic regimen containing aprepitant, dexamethasone and ondansetron among children receiving highly emetogenic chemotherapy (HEC) in India, Bangladesh, Indonesia, the UK and the USA.MethodsHealth states were estimated using individual patient-level outcome data from a randomised trial. The incremental cost–utility ratio (ICUR), incremental cost-effectiveness ratio and net monetary benefit (NMB) were calculated from the patient perspective for India, Bangladesh, Indonesia, the UK and the USA. One-way sensitivity analysis was done by varying the cost of olanzapine, cost of hospitalisation and utility values by ±25%.ResultsThe olanzapine arm had an increment of 0.0018 quality-adjusted life-years (QALY) over the control arm. The mean total expenditure in the olanzapine arm was greater by US$0.51, US$0.43, US$6.73, US$11.05 and US$12.35 in India, Bangladesh, Indonesia, the UK and the USA, respectively. The ICUR($/QALY) was US$282.60 in India, US$241.42 in Bangladesh, US$3755.93 in Indonesia, US$6161.83 in the UK and US$6887.41 in the USA. The NMB was US$9.86, US$10.12, US$14.08, US$44.74 and US$98.79 for India, Bangladesh, Indonesia, the UK and the USA, respectively. The ICUR estimates of the base case and sensitivity analysis were below the willingness-to-pay threshold in all scenarios.ConclusionThe addition of olanzapine as a fourth agent for antiemetic prophylaxis is cost-effective despite an increase in overall expenditure. Olanzapine should be uniformly considered for children receiving HEC.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

“…The methodology used for cost-effectiveness analysis in this study is similar to our previous work evaluating the cost-effectiveness of aprepitant for children receiving HEC 13…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Olanzapine cost-effectiveness in vomiting and nausea from highly emetogenic chemotherapy in children and adolescents

Singh

Ganguly

Naik

et al. 2023

BMJ Support Palliat Care

Self Cite

View full text Add to dashboard Cite

show abstract

“…Additionally, the cost-effectiveness of newer anti-emetics is an important aspect that needs to be incorporated while designing institute-or country-specific anti-emetic guidelines. Aprepitant as a third prophylactic agent and olanzapine as a fourth prophylactic agent for CINV were found to be cost-effective from both a high-income and a low-middle income perspective; yet, such studies should be prospectively conducted with newer agents before including the use of these drugs in guidelines [92,93].…”

Section: Discussionmentioning

confidence: 99%

Anti-Emetics in Children Receiving Chemotherapy for Solid Tumors and Leukemia: Pharmacology and Optimization of Therapy for Nausea and Vomiting

Ganguly,

Sasi,

Nagaraju

et al. 2024

Pharmaceuticals

Self Cite

View full text Add to dashboard Cite

The management of chemotherapy-induced nausea and vomiting (CINV) in children remains challenging due to differences in the chemotherapy regimens, their relative emetogenicity compared to that in adults and differences in drug metabolism and the available formulations. The common four classes of anti-emetics used for the treatment and prophylaxis of CINV in children include dexamethasone, neurokinin-1 receptor antagonists, 5-hydroxytryptamine-3 receptor antagonists (5HT3RAs), and olanzapine. The appropriate dose of dexamethasone for CINV prophylaxis in children is unknown, with a significant variability in dosage ranging between 6 and 32 mg/m2/day. The dose of dexamethasone is decreased by 30% when this drug is combined with (fos)aprepitant in children, in contrast to a decrease of 50% required in adults. The use of aprepitant in younger children (<12 years) is often hampered by the non-availability of oral suspension formulations in many countries; alternatively, 80 mg capsules are administered for 1–3 days in certain institutes to children weighing between 15 and 40 kg. Among the different 5HT3RAs, palonosetron is comparatively metabolized faster in children than in adults, requiring a higher dosage for similar efficacy to that achieved in adults. Olanzapine is a newer agent, used in doses between 0.1 and 0.14 mg/kg/day in children, with good anti-emetic efficacy, but has sedation and hyperglycemia as concerning adverse effects. Drug interactions between anti-emetics and between anti-emetics and chemotherapy/supportive agents (azole antifungals, cyclosporine, arsenic trioxide), especially QTc prolongation, should be considered during prescription.

show abstract

Antiemetic medications for preventing chemotherapy-induced nausea and vomiting in children: a systematic review and Bayesian network meta-analysis

Walker,

Dias,

Phillips

2024

Support Care Cancer

View full text Add to dashboard Cite

Purpose Children continue to experience chemotherapy-induced nausea and vomiting (CINV), despite effective antiemetic medications. Recommendations in clinical practice guidelines are underpinned by narrative syntheses and meta-analyses that compare only two treatments. This means not all antiemetics have been compared to one another, and estimates remain imprecise. We apply network meta-analysis (NMA) to overcome these limitations by comparing multiple treatments simultaneously. Methods A systematic review identified and critically appraised RCTs comparing antiemetics recommended and licensed for the prevention of CINV in children. Bayesian NMA compared and ranked antiemetic effectiveness for the outcomes complete (CR) and partial response (PR) in the acute, delayed, and overall phases, nausea, and decreased food intake. Antiemetics given with and without dexamethasone were compared in separate networks as their underlying populations differed. Results Sixteen RCTs (3115 patients receiving moderately (MEC) or highly emetogenic chemotherapy (HEC)) were included. When given with dexamethasone, NK1 antagonists with ondansetron ranked highest for CR and PR in the acute and overall phases, PR in the delayed phase, and decreased food intake. Post hoc analysis shows further a benefit of adding olanzapine to regimens of aprepitant and ondansetron. Ondansetron ranked lower than palonosetron, for CR in the delayed and overall phases, and ondansetron was less effective than palonosetron for nausea prevention. Rankings for other regimens, including those given without dexamethasone, were uncertain or inconsistent across outcomes. Conclusions Our findings serve to support the current recommendations of olanzapine (when given with aprepitant and ondansetron) and NK1 antagonists’ regimens receiving HEC, but note that evidence of a significant difference in relative benefit, between patients receiving MEC and HEC, does not yet exist. Recommendations for palonosetron as the preferred 5HT3 antagonists may be extended, particularly, to those who are at high risk of nausea.

show abstract

Cost‐effectiveness analysis of aprepitant‐based anti‐emetic regimen for children receiving highly emetogenic chemotherapy: Individual patient data analysis of a randomized trial

Cited by 3 publications

References 28 publications

Olanzapine cost-effectiveness in vomiting and nausea from highly emetogenic chemotherapy in children and adolescents

Olanzapine cost-effectiveness in vomiting and nausea from highly emetogenic chemotherapy in children and adolescents

Anti-Emetics in Children Receiving Chemotherapy for Solid Tumors and Leukemia: Pharmacology and Optimization of Therapy for Nausea and Vomiting

Antiemetic medications for preventing chemotherapy-induced nausea and vomiting in children: a systematic review and Bayesian network meta-analysis

Contact Info

Product

Resources

About