DOI QR코드

DOI QR Code

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

  • Published : 2013.12.31

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.

References

  1. Aleyasin A, Hanafi S, Saffarieh E, et al (2012). Efficacy of generic granisetron vs $Kytril^{(R)}$ for PONV in major gynecological operations: a randomized, double-blind clinical trial. Iranian J Pharm Res, 11, 1059-64.
  2. Almazron S and Alnaim L (2012). Evaluation of adherence to chemotherapy-induced nausea and vomiting guidelines. An observational study. J Cancer Therapy, 3, 613-20. https://doi.org/10.4236/jct.2012.35078
  3. Annemans L, Strens D, Lox E, et al (2008). Cost-effectiveness analysis of aprepitant in the prevention of chemotherapyinduced nausea and vomiting in Belgium. Support Care Cancer, 16, 905-15. https://doi.org/10.1007/s00520-007-0349-1
  4. Ballatori E, Roila F, Berto P, et al (1994). Cost and costeffectiveness analysis of ondansetron versus metoclopramide regimens: a hospital perspective from Italy. Pharmacoeconomics, 5, 227-37. https://doi.org/10.2165/00019053-199405030-00006
  5. Burmeister H, Achi S, Studer C, et al (2012). Adherence to ESMO clinical recommendations for prophylaxis of chemotherapy-induced nausea and vomiting. Supp Care Cancer, 20, 141-7. https://doi.org/10.1007/s00520-010-1079-3
  6. Chan HK, Phua G, Kassim MS, et al (2013). Can granisetron injection used as primary prophylaxis improve the control of nausea and vomiting with low-emetogenic chemotherapy? Asian Pac J Cancer Prev, 14, 469-73. https://doi.org/10.7314/APJCP.2013.14.1.469
  7. Colayco DC and Hay J (2010). Cost-effectiveness of serotonintype 3 receptor antagonists for chemotherapy-induced emesis in non-small cell lung cancer patients receiving cisplatinbased chemotherapy. Value Health, 13, 41.
  8. Cox F and Hirsch J (1993). Ondansetron: a cost-effective advance in anti-emetic therapy. Oncol, 50, 186-90. https://doi.org/10.1159/000227175
  9. Cunningham D, Gore M, Davidson N, et al (1993). The real costs of emesis - an economic analysis of ondansetron versus metoclopramide in controlling emesis in patients receiving chemotherapy for cancer. Eur J Cancer, 29, 303-6.
  10. Erntoft S (2011). Pharmaceutical priority setting and the use of health economic evaluations: a systematic literature review. Value Health, 14, 587-99. https://doi.org/10.1016/j.jval.2010.10.036
  11. Ettinger DS, Armstrong DK, Barbour S, et al (2012). Antiemesis. JNCCN, 10, 456-85.
  12. Hassali MA, Thambyappa J, Nambiar S, et al (2013). TRIPS, Free Trade Agreements and the Pharmaceutical Industry in Malaysia. In "The New Political Economy of Pharmaceuticals: Production, Innnovation and TRIPS in the Global South", Eds Lofgren H and Williams OD. Palgrave Macmillan, Basingstoke pp 152-66.
  13. Humphreys S, Pellissier J, Jones A (2013). Cost-effectiveness of an aprepitant regimen for prevention of chemotherapyinduced nausea and vomiting in patients with breast cancer in the UK. Cancer Manag Res, 5, 215-24.
  14. Ismail F, Mohamed AK, Lim KH, et al (2011). Systemic therapy of cancer, 2nd edition. Ministry of Health, Kuala Lumpur, 75-8.
  15. Jordan K, Hinke A, Grothey A et al (2007). A meta-analysis comparing the efficacy of four 5-HT3-receptor antagonists for acute chemotherapy-induced emesis. Support Care Cancer, 15, 1023-33. https://doi.org/10.1007/s00520-006-0186-7
  16. Jordan K, Schmoll HJ, Aapro MS (2007). Comparative activity of antiemetic drugs. Oncol Hemato, 61, 162-75.
  17. Koeller JM, Aapro MS, Gralla RJ, et al (2002). Antiemetic guidelines: creating a more practical treatment approach. Supp Care Cancer, 10, 519-22. https://doi.org/10.1007/s00520-001-0335-y
  18. Kris MG, Hesketh PJ, Herrstedt J, et al (2005). Consensus proposals for the prevention of acute and delayed vomiting and nausea following high-emetic-risk chemotherapy. Supp Care Cancer, 13, 85-96. https://doi.org/10.1007/s00520-004-0699-x
  19. Lordick F, Ehlken B, Ihbe-Heffinger A, et al (2007). Health outcomes and cost-effectiveness of aprepitant in outpatients receiving antiemetic prophylaxis for highly emetogenic chemotherapy in Germany. Eur J Cancer, 43, 299-307. https://doi.org/10.1016/j.ejca.2006.09.019
  20. Lopes G, Burke T, Pellissier J, et al (2012). Aprepitant for patients receiving highly-emetogenic chemotherapy: an economic analysis for Singapore. Value Health Regional Iss, 1, 66-74. https://doi.org/10.1016/j.vhri.2012.03.002
  21. Marshall DA and Hux M (2009). Design and analysis issues for economic analysis alongside clinical trials. Med Care, 47, 14-20. https://doi.org/10.1097/MLR.0b013e3181a31971
  22. Moore S, Tumeh J, Wojtanowski S, et al (2007). Cost-effectiveness of aprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with highly emetogenic chemotherapy. Value Health, 10, 23-31. https://doi.org/10.1111/j.1524-4733.2006.00141.x
  23. Pharmacy Services Division Malaysia (2011). Drug Formulary. Ministry of Health, Kuala Lumpur pp 37.
  24. Rothermel C (2013). What is health economics and outcome research? A primer for medical writers. Am Med Writers Assoc J, 28, 98-104.
  25. Uyl-de Groot CA, Wait S, Buijt I (2000). Economics and healthrelated quality of life in antiemetic therapy: recommendations for trial design. Eur j Cancer, 36, 1522-35. https://doi.org/10.1016/S0959-8049(00)00132-5
  26. Yonemura M, Katsumata N, Hashimoto H, et al (2009). Randomized controlled study comparing two doses of intravenous granisetron (1 and 3 mg) for acute chemotherapy-induced nausea and vomiting in cancer patients: a non-inferiority trial. Jpn J Clin Oncol, 39, 443-8. https://doi.org/10.1093/jjco/hyp036

Cited by

  1. Phase II Study on EANI Combined with Hydrochloride Palonosetron for Prevention of Chemotherapy-induced Nausea and Vomiting Following Highly Emetogenic Chemotherapy vol.15, pp.9, 2014, https://doi.org/10.7314/APJCP.2014.15.9.3951
  2. Aprepitant in the Prevention of Vomiting Induced by Moderately and Highly Emetogenic Chemotherapy vol.15, pp.23, 2015, https://doi.org/10.7314/APJCP.2014.15.23.10045
  3. Prevention of Chemotherapy-Induced Nausea and Vomiting in Cancer Patients vol.16, pp.15, 2015, https://doi.org/10.7314/APJCP.2015.16.15.6207