Pharmacoeconomic analysis of prophylactic treatments for emesis secondary to breast cancer chemotherapy

The objectives of this study were to perform a cost effectiveness analysis of ondansetron plus dexamethasone against standard metoclopramide antiemetic combinations in the prevention of acute and delayed emesis following breast cancer chemotherapy protocols administered within the institutional setting. A retrospective chart review was conducted on 163 inpatients who received 5-fluorouracil, cyclophosphamide and epirubicin (FEC) or doxorubicin (FAC). The proportion of patients with complete control of emesis within the first 24 hours (acute) and between 24-72 hours after the completion of chemotherapy (delayed) were determined. A comparative cost model was applied from a hospital perspective. Costs of primary therapy, rescue therapy, nursing costs for breakthrough emesis, extended hospitalization for uncontrolled emesis, and side effects were included in this calculation. The percentage of patients in the ondansetron group who experienced complete emesis control in the acute period was 69.4% compared to 49.2% in the metoclopramide group (p = 0.015). The incremental cost in the ondansetron group was $26.83 per additional episode of emesis avoided. In the delayed emetic time frame, patients on ondansetron and those on the metoclopramide regimen had comparable rates of complete control of emesis, 58.2% vs. 47.7% (p = 0.25), respectively. The incremental ondansetron cost was $80.19 per episode of emesis avoided. The results of this analysis suggest that ondansetron in combination with dexamethasone is an economically attractive treatment strategy in the hospital setting for the prevention of acute emesis. The use of ondansetron beyond the first 24 hours following moderately emetogenic chemotherapy becomes a more expensive treatment.