Cost-Effectiveness Analysis of Granisetron-Based versus Standard Antiemetic Regimens in Low-Emetogenic Chemotherapy: A Hospital-based Perspective from Malaysia

Abstract

Background: In a prospective cohort study of antiemetic therapy conducted in Malaysia, a total of 94 patients received low emetogenic chemotherapy (LEC) with or without granisetron injections as the primary prophylaxis for chemotherapy-induced nausea and vomiting (CINV). This study is a retrospective cost analysis of two antiemetic regimens from the payer perspective. Materials and Methods: This cost evaluation refers to 2011, the year in which the observation was conducted. Direct costs incurred by hospitals including the drug acquisition, materials and time spent for clinical activities from prescribing to dispensing of home medications were evaluated (MYR 1=$0.32 USD). As reported to be significantly different between two regimens (96.1% vs 81.0%; p=0.017), the complete response rate of acute emesis which was defined as a patient successfully treated without any emesis episode within 24 hours after LEC was used as the main indicator for effectiveness. Results: Antiemetic drug acquisition cost per patient was 40.7 times higher for the granisetron-based regimen than for the standard regimen (MYR 64.3 vs 1.58). When both the costs for materials and clinical activities were included, the total cost per patient was 8.68 times higher for the granisetron-based regimen (MYR 73.5 vs 8.47). Considering the complete response rates, the mean cost per successfully treated patient in granisetron group was 7.31 times higher (MYR 76.5 vs 10.5). The incremental cost-effectiveness ratio (ICER) with granisetron-based regimen, relative to the standard regimen, was MYR 430.7. It was found to be most sensitive to the change of antiemetic effects of granisetron-based regimen. Conclusions: While providing a better efficacy in acute emesis control, the low incidence of acute emesis and high ICER makes use of granisetron as primary prophylaxis in LEC controversial.

Untitled

“…Although the two antiemetic combinations didn't show any significant difference in the prevention of CINV there was considerable difference in the terms of their costs. The combination including granisetron was almost ten times more expensive compared to one with ondansetron during five days of antiemetic treatment, similarly to the study done in Malaysia 23 . The study showed that both antiemetic combinations (Ondansetron or Granisetron) were effective to prevent CINV but the control was better in acute compared to the delayed phase.…”

Applicability of the National Comprehensive Cancer Network/Multinational Association of Supportive Care in Cancer Guidelines for Prevention and Management of Chemotherapy-Induced Nausea and Vomiting in Southeast Asia: A Consensus Statement

“…Adding a 5-HT 3 antagonist to single-agent therapy with dexamethasone or metoclopramide is not cost-effective in this setting. 46 …”

Olanzapine for Preventing Nausea and Vomiting Induced by Moderately and Highly Emetogenic Chemotherapy

“…However, the primary regimen often has to be adjusted or even discontinued due to adverse events, with the chemotherapy-induced nausea and vomiting (CINV) being the most common one, which not only greatly increases the economic burden (Keat and Ghani, 2013) but also produces dehydration, electrolyte disturbance, sub-nutrition, anorexia, weight loss, hypodynamia, sleep deficit, esophageal laceration, and massive hemorrhage, which seriously reduce patients' quality of life (QoL) and are even life-threatening. These limitations hamper the progress of chemotherapy (Hassan and Yusoff, 2010;Uchino et al, 2012;Janelsins et al, 2013).…”