Cost-consequence analysis of aprepitant compared to standard therapy (5-HT3 + corticosteroids) for the prevention of highly emetogenic chemotherapy-induced nausea and vomit

Analisi di cost-consequence di aprepitant rispetto alla terapia standard (5-HT3 più corticosteroidi) nella profilassi di un episodio di nausea e vomito indotto da chemioterapia altamente emetogena

Abstract

Introduction Prevention of chemotherapy-induced nausea and vomiting (CINV) remains an important goal for patients receiving cytotoxic treatment. The objective of this study was to assess, from the Italian National Health Service payer perspective, the costs of an antiemetic regimen using aprepitant, a selective neurokinin-1 receptor antagonist, for patients receiving highly emetogenic chemotherapy. Methods A decision-analytic model was developed to compare an aprepitant regimen (aprepitant, ondansetron, and dexamethasone) with a standard antiemetic regimen (ondansetron and dexamethasone) for expected costs after highly emetogenic chemotherapy. The model was populated with clinical results from patients treated with high-dose cisplatin in a randomized trial of CINV prevention therapy. Only direct medical costs (pharmacological treatment and emesis) – Euro 2014 – were considered. Sensitivity and threshold analyses on key clinical and economic parameters were performed. Results The aprepitant regimen showed the lower expected treatment cost (aprepitant regimen: €109.01; standard antiemetic regimen: €110.44). The acquisition cost of aprepitant regimen (aprepitant regimen: €85.29; standard antiemetic regimen: €74.24) was offset by reduced health care resource utilization costs for CINV (aprepitant regimen: €23.72; standard antiemetic regimen: €36.20). Sensitivity and threshold analyses confirmed the base case results. Conclusions Results of this cost-consequence analysis suggest that, from the Italian National Health Service payer perspective, the aprepitant regimen is a cost-saving strategy compared with an antiemetic regimen without aprepitant in the prevention of highly emetogenic chemotherapy-induced nausea and vomiting.