The real costs of emesis—An economic analysis of ondansetron vs. Metoclopramide in controlling emesis in patients receiving chemotherapy for cancer

Cunningham, David; Gore, Martin; Davidson, N.; Miocevich, M.; Manchanda, Mansi; Wells, Nicholas

doi:10.1016/0959-8049(93)90372-m

Cited by 37 publications

(13 citation statements)

References 2 publications

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“…This was mainly attributable to the high differential cost between the original granisetron (Kytril ® ) and generic metoclopramide or dexamethasone marketed in Malaysia. Unlike most of the previous pharmacoeconomic studies of antiemetics in chemotherapy which had favored the new treatment (Cox and Hirsch, 1993;Cunningham et al, 1993;Lordick et al, 2007;Lopes et al, 2012;Humphreys et al, 2013), our results had indicated a high ICER (MYR 430.66 per successfully treated patient) of granisetron-based regimen relative to standard regimen. To date, Malaysia does not have a published threshold to determine costeffectiveness of antiemetics.…”

Section: Discussioncontrasting

confidence: 94%

“…Antiemetic treatment is always the target of these studies due to its high acquisition cost and the lack of curative effects (Uyl-de Groot et al, 2000). To date, almost all the pharmacoeconomic studies of antiemetic treatment have been targeting the most costly items including aprepitant (Lordick et al, 2007;Moore et al, 2007;Annemans et al, 2008;Lopes et al, 2012) and serotonin type-3 (5HT-3) antagonists (Cox and Hirsch, 1993;Cunningham et al, 1993;Ballatori et al, 1994;Colayco and Hay, 2010). Overall, most of the findings showed that adding these new agents to the traditional antiemetic regimens provides incremental benefits in terms of cost-effectiveness.…”

Section: Cost-effectiveness Analysis Of Granisetron-based Versus Stanmentioning

confidence: 99%

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

Keat

Ghani²

2013

Asian Pacific Journal of Cancer Prevention

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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.

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Section: Discussioncontrasting

confidence: 94%

Section: Cost-effectiveness Analysis Of Granisetron-based Versus Stanmentioning

confidence: 99%

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

Keat

Ghani²

2013

Asian Pacific Journal of Cancer Prevention

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“…This prospective, randomised, cost-effectiveness study compared ondansetron and metoclopramide in hospital ised patients receiving highly emetogenic chemotherapy including cisplatin. This study has been published in full [4] and is summarised here.…”

Section: Introductionmentioning

confidence: 99%

Ondansetron: A Cost-Effective Advance in Anti-Emetic Therapy

Cox

Hirsch²

1993

Oncology

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A cost-effectiveness analysis is one form of full economic evaluation where drug acquisition costs and the costs that are incurred as a result of using a particular treatment are assessed together with clinical efficacy. This paper reviews two such studies. One of the studies was a prospective randomised cost-effectiveness study which compared ondansetron (8 mg i.v. 0, 4 and 8 h following chemotherapy) with metoclopramide (3 mg/kg i.v. followed by an infusion of 0.5 mg/kg/h for 8 h) over the first 24 h following chemotherapy in hospitalised patients receiving highly emetogenic chemotherapy. This study showed that the cost per successfully treated patient (defined in this study as having < 1 emetic episode and no adverse events) for these 2 treatments were approximately equal: ondansetron E95 and metoclopramide E92. The second study was an economic evaluation based on data collected over a 5-day period following cyclophosphamide-based chemotherapy given on an outpatient basis for the treatment of breast cancer. Patients received an intravenous dose of 16 mg dexamethasone with either 8 mg ondansetron or 60 mg metoclopramide intravenously before chemotherapy followed by oral dosing with 8 mg ondansetron or 20 mg metoclopramide 3 times daily for 5 days. The costs per successfully treated patient (defined in this study as no vomiting or retching episodes and no anti-emetic-related adverse events during the 5-day period) were comparable: ondansetron E184 and metoclopramide E160. A recent study has established that ondansetron (8 mg) given orally twice daily is as effective as the same dose given 3 times a day. A sensitivity analysis using the cost of an ondansetron twice daily regimen showed that ondansetron is more cost-effective than metoclopramide (E133 vs. E 160). These cost effectiveness studies have shown that ondansetron is at least as cost-effective as metoclopramide and simplified ondansetron dosing schedules render ondansetron more cost-effective. These full economic evaluations illustrate that drug acquisition costs can be a misleading guide to the economic impact of antiemetics.

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“…tional SEK 460-810 to the cost (13)(14)(15)(16). The cost for treating emesis, on the other hand, decreased so that the extra health care cost per treatment cycle was approximately SEK 200-600 in 1996.…”

Section: Outpatient Carementioning

confidence: 99%

Cancer Treatment in Sweden - Costs of Drugs, Inpatient and Outpatient Care from 1985 to 1996 and Cost Effectiveness of New Drugs

Tennvall

Karlsson²

1998

Acta Oncologica

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The real costs of emesis—An economic analysis of ondansetron vs. Metoclopramide in controlling emesis in patients receiving chemotherapy for cancer

Cited by 37 publications

References 2 publications

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

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

Ondansetron: A Cost-Effective Advance in Anti-Emetic Therapy

Cancer Treatment in Sweden - Costs of Drugs, Inpatient and Outpatient Care from 1985 to 1996 and Cost Effectiveness of New Drugs

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