INTERNATIONAL RESEARCH & OPINION

Is ondanselron cost effective ...

... for patients undergoing antineoplastic therapy?

The cost/successfully treated patient is only 1.4-fold greater for ondansetron than that for standard antiemetic therapy in patients receiving antineoplastic therapy, according to researchers from the Institute of Oncology and Radiology, Serbia, Yugoslavia. 1

Their analysis involved 30 patients with ovarian cancer who received high-dose cisplatin and cyclophosphamide. The cost-effectiveness of ondansetron was compared with that for the standard combination of antiemetic drugs including high­dose metoclopramide* and that for routine therapy with low doses of metoclopramide and diazepam.

The total direct costs associated with antiemetic therapy were DM67.53 for ondansetron, DM53.33 for ondansetron + dexamethasone, DM32.62 for standard treatment and DM1O.81 for routine treat­ment [see table]. Respective rates of successful treatment were 87%, 90%, 60% and 20%. Thus, the cost/successfully treated patient was DM77.62 for ondansetron, DM59.25 for ondansetron + dexamethasone, DM54.36 standard treatment and DM54.05 routine treatment.

Average direct costslpatient associated with different antiemetic regimens (OM)

Coat "*"- On~ Ond8nMtron + St.ndard· RoutlMl deDlMthelone

Acquisition 64.80 48.04 13.50 3.01

AdmInistration 0.54 5.60 12.32 7.80

Rescue 0.04 0.03 0.19 0 antlemetics

Matellals 0.07 0.06 0.21 0

1 =~satIon 2.08 1.60 6.40 0

• Hlgl-doee metocIopramlde + daxameIhasone + cImet .'ialna + ctazepem , Low-doae metoc:IopfemIde + ~

The researchers conclude that the ondansetron + dexamethasone combination is the most cost­effective alternative, based on the percentage of successfully treated patients. In contrast, they believe that routine therapy with low doses of metoclopramide and diazepam is ineffective and, hence, 'unethical and economically unreasonable' .

. . . in postoperative nausea and vomiting? The cost-effectiveness ratio for ondansetron is

$US260/patient in whom postoperative nausea and vomiting is avoided, according to Drs Alix Mathieu and Alfonso Lofez from the University of Cincinnati, US.

They conducted a meta-analysis of randomised controlled trials (RCTs) comparing ondansetron with placebo and other antiemetics in the prevention of postoperative nausea and vomiting. An economic model was also developed to compare ondansetron prophylaxis for patients undergoing surgery

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(n = 10(0) with no prophylaxis (1000) from the hospital and patient/insurer perspectives.

Over 24 hours, the likelihood of postoperative vomiting and nausea was 2.5- and 2. I-fold lower among ondansetron, than among placebo, recipients, respectively. Also, the need for rescue antiemetic therapy (e.g. droperidol) was O.4-fold lower for ondansetron, compared with placebo, recipients. The cost-effectiveness ratio for ondansetron from the patient/insurer perspective is $260/patient in whom postoperative nausea and vomiting is avoided. * High-dose metoclopramide + dexamethasone + dimenhydrinate + diazepam These papers were presented as posters at the 10th International Conference on Pharmacoepidemiology in Stockholm, Sweden. 1. Raduiovic S. et aI. Efficacy of ondansetron makes it a cost·effective advance in prevention of acute emesis due to highly emetogenic chemotherapy. 10th International Conference on Phannacoepidemiology : 4. 1994 2. Mathieu A. et aI. Guidelines for a comprehensive evaIuation of the effectiveness and economic efficiency of new drugs in anesthesia practice prior to their adoption: meta-analysis of ondansetron. postoperative anti-emetic efficacy and cost-effectiveness analysis of PONV prevention in adulls. 10th International Conference on Phannacoepidemiology : 16. 1994

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PHARMACORESOURCES 5 Nov IBM

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