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Sra MS, Ganguly S, Sasi A, Sharma P, Giri RK, Rasheed AA, Bakhshi S. Cost-effectiveness analysis of aprepitant-based anti-emetic regimen for children receiving highly emetogenic chemotherapy: Individual patient data analysis of a randomized trial. Pediatr Blood Cancer 2022; 69:e29795. [PMID: 35652531 DOI: 10.1002/pbc.29795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Aprepitant has been shown to reduce chemotherapy-induced nausea and vomiting in children receiving highly emetogenic chemotherapy (HEC). In this study, we assessed the cost-effectiveness of aprepitant for children receiving HEC in India, United Kingdom, and the United States. PROCEDURE We utilized individual patient-level outcome data from a pediatric randomized trial, which demonstrated the superiority of an aprepitant-based anti-emetic prophylaxis over standard ondansetron and dexamethasone for HEC. Health state for each day of follow-up was analyzed and quality-adjusted life years (QALYs) were estimated. The incremental cost-utility ratio (ICUR), incremental cost-effectiveness ratio (ICER), and net monetary benefit (NMB) for each country were estimated. Sensitivity analyses by varying cost of aprepitant, hospitalization, and health state utility values by ±25% were conducted. RESULTS Use of the aprepitant-based regimen resulted in gain of 0.0019 QALY per chemotherapy cycle along with cost savings of $22.25, $1335.52, and $6612.10 for India, United Kingdom, and the United States, respectively. The cost savings per QALY was estimated to be $12,355.84 for India, $734,282.90 for the United Kingdom, and $3,567,564.11 for the United States. The cost savings for 50% gain in the percentage of days without grade 3 vomiting was $124.18 for India, $7451.63 for the United Kingdom, and $36,892.76 for the United States. The NMB for gain in QALY was $33.62, $1418.60, and $6727.01 for India, United Kingdom, and the United States, respectively. The estimates remained cost-effective across all scenarios of the sensitivity analyses. CONCLUSION Aprepitant-based anti-emetic regimen is cost-effective for children receiving HEC. It results in overall cost savings and reduced healthcare-resource utilization.
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Affiliation(s)
- Manraj Singh Sra
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shuvadeep Ganguly
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Sasi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Sharma
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rupak Kumar Giri
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Azgar Abdul Rasheed
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Xu X, Bao Y, Xu K, Zhang Z, Zhao N, Li X. Economic Value of Fosaprepitant-Containing Regimen in the Prevention of Chemotherapy-Induced Nausea and Vomiting in China: Cost-Effectiveness and Budget Impact Analysis. Front Public Health 2022; 10:913129. [PMID: 35903377 PMCID: PMC9315060 DOI: 10.3389/fpubh.2022.913129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/20/2022] [Indexed: 12/24/2022] Open
Abstract
Objective The purpose of this study was to evaluate the cost-effectiveness and budget impact of fosaprepitant (FosAPR)-containing regimen for the prevention of chemotherapy-induced nausea and vomiting (CINV) among patients receiving high emetogenic chemotherapy (HEC) from the Chinese payer's perspective. Methods A decision tree model was established to measure the 5-day costs and health outcomes between the APR-containing regimen (aprepitant, granisetron, and dexamethasone) and FosAPR-containing regimen (fosaprepitant, granisetron, and dexamethasone). Clinical data were derived from a randomized, double-blind controlled trial on Chinese inpatients who received HEC. Quality-adjusted life-years (QALYs) were used to estimate the utility outcomes and the incremental cost-effectiveness ratio (ICER) was calculated to assess the economics of FosAPR. A static budget impact model was developed to assess the impact of FosAPR as a new addition to the National Reimbursement Drug List (NRDL) on the medical insurance fund within 3 years in Nanjing, China. Results Compared with APR, FosAPR had a mean health-care savings of ¥121.56 but got a reduction of 0.0001815 QALY, resulting in an ICER of ¥669926.19 per QALY. Deterministic sensitivity analysis revealed that the cost of APR was the most influential factor to the ICER. The cost of FosAPR and the complete control rate of the delayed period also had a high impact on the results. According to the probabilistic analysis, the acceptability of FosAPR was more than 80% when the Chinese willingness-to-pay (WTP) was ¥215,999. FosAPR would lead to a 3-year medical insurance payment increase of ¥1.84 million compared with ¥1.49 million before FosAPR entered NRDL in Nanjing. The total budget increased with a cumulative cost of ¥694,829 and covered an additional 341 patients who benefited from FosAPR in Nanjing. Deterministic sensitivity analysis showed that the model of budget impact analysis was stable. Conclusion FosAPR had a similar treatment effect to APR but was cost-effective in China at the current WTP threshold. The total budget of medical insurance payments of Nanjing slightly increased year by year after the inclusion of FosAPR. Its inclusion in the NRDL would be acceptable and also expand the coverage of patients who benefited from FosAPR.
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Affiliation(s)
- Xinglu Xu
- Department of Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Yuwen Bao
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Kai Xu
- Department of Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Zhuolin Zhang
- Department of Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Ningli Zhao
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Xin Li
- Department of Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, China
- Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Xin Li
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Qiu T, Men P, Sun T, Zhai S. Cost-Effectiveness of Aprepitant in Preventing Chemotherapy-Induced Nausea and Vomiting: A Systematic Review of Published Articles. Front Public Health 2021; 9:660514. [PMID: 34513778 PMCID: PMC8424090 DOI: 10.3389/fpubh.2021.660514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives: The aim of this systematic review is to assess the published cost-effectiveness analyses of aprepitant for patients with chemotherapy-induced nausea and vomiting (CINV). Methods: A systematic literature search was performed on PubMed, EMbase, the Cochrane Library, CNKI, WANFANG DATA, and CBM database. The date of publication is up to January 2019. Two reviewers independently reviewed titles, abstracts, and articles sequentially to select studies for data abstraction based on the inclusion and exclusion criteria. Disagreements were resolved and reviewers reached a consensus. The quality of the included studies was assessed according to the 24-item checklist of the consolidated health economic evaluation reporting standards (CHEERS). The costs reported by the included studies were converted to US dollars via purchasing power parities (PPP) in the year 2019 using the CCEMG–EPPI–Certer Cost Converter. Results: Thirteen articles were included based on the inclusion criteria for cost-effectiveness analysis and cost-utility analysis. Twelve studies were rated as good quality and one as a moderate quality based on the CHEERS checklist. Eight studies compared aprepitant plus 5-hydroxytryptamine-3 receptor antagonist (5-HT3RA) and dexamethasone with the standard regimen (5-HT3RA and dexamethasone). It was concluded that aprepitant plus standard regimen was a cost-effective strategy for preventing CINV. Only one study that compared aprepitant plus 5-HT3RA with 5-HT3RA, concluded that the addition of aprepitant reduced the incidence of severe nausea, and it might also provide an economic benefit in the overall management. Four studies that compared aprepitant with other antiemetic drugs concluded that aprepitant is a cost-effective strategy for preventing CINV compared with metoclopramide. However, netupitan + palonosetron and olanzapine are cost-effective compared with aprepitant. Conclusion: This study is the first systematic evaluation of adding aprepitant to standard regimens for patients with CINV. Most economic evaluations of antiemetic medications are reported to be of good quality. Adding aprepitant to standard regimens is found to be a cost-effective strategy for preventing CINV.
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Affiliation(s)
- Tingting Qiu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Peng Men
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Tong Sun
- Department of Pharmacy, Aviation General Hospital, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
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4
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Yoshida I, Tamura K, Miyamoto T, Shimokawa M, Takamatsu Y, Nanya Y, Matsumura I, Gotoh M, Igarashi T, Takahashi T, Aiba K, Kumagai K, Ishizawa K, Kurita N, Usui N, Hatake K. Prophylactic Antiemetics for Haematological Malignancies: Prospective Nationwide Survey Subset Analysis in Japan. In Vivo 2019; 33:1355-1362. [PMID: 31280230 DOI: 10.21873/invivo.11611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/18/2019] [Accepted: 06/24/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND/AIM Although neurokinin-1 receptor antagonists are approved chemotherapy drugs in Japan, no nationwide surveys have been performed to validate chemotherapy-induced nausea and vomiting (CINV) guidelines in clinical practice. This study evaluated CINV in patients with haematological malignancies starting first-time chemotherapy. PATIENTS AND METHODS A nationwide CINV survey on patients with haematological malignancies was conducted at 118 institutions. Patients undergoing moderately emetic chemotherapy (n=17) and highly emetic chemotherapy (HEC; n=180) were compared. RESULTS Forty-one patients undergoing HEC received triple antiemetics. Female gender and young age were risk factors for early-phase nausea, while female gender remained a risk factor for late-phase nausea and vomiting. Among 125 patients receiving CHOP (doxorubicin, cyclophosphamide, vincristine, prednisone)-like regimens, complete response and complete control were increased in patients receiving triple antiemetics, compared to those with double antiemetics. CONCLUSION Guideline compliance was very low. Although not statistically significant, there was a trend for reduced CINV and improved disease control for triple versus double antiemetics, suggesting that triple antiemetics should be considered for HEC, especially in young female patients with non-Hodgkin lymphoma receiving CHOP-like regimens.
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Affiliation(s)
- Isao Yoshida
- Department of Hematologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Kazuo Tamura
- General Medical Research Center, Fukuoka University, Fukuoka, Japan.,Division of Medical Oncology, Hematology and Infectious Disease, Fukuoka University, Fukuoka, Japan
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic Science, Kyushu University Faculty of Medicine, Fukuoka, Japan
| | - Mototsugu Shimokawa
- Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yasushi Takamatsu
- Division of Medical Oncology, Hematology and Infectious Disease, Fukuoka University, Fukuoka, Japan
| | - Yasuhito Nanya
- Department of Hematology and Oncology, The University of Tokyo, Tokyo, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Moritaka Gotoh
- Department of Hematology, Tokyo Medical University, Tokyo, Japan
| | - Tadahiko Igarashi
- Hematology/Oncology Division, Gunma Prefectural Cancer Center, Ohta, Japan
| | - Tsutomu Takahashi
- Department of Oncology/Hematology (Department of 3rd Internal Medicine), Cancer Center, Shimane University, Izumo, Japan
| | - Keisuke Aiba
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Kyoya Kumagai
- Division of Hematology-Oncology, Chiba Cancer Center, Chiba, Japan
| | - Kenichi Ishizawa
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Kurita
- Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Noriko Usui
- Department of Clinical Oncology and Hematology, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Kiyohiko Hatake
- Department of Hematology Oncology, The Cancer Institute Hospital of JFCR, Tokyo, Japan
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5
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Pojawa-Gołąb M, Jaworecka K, Reich A. NK-1 Receptor Antagonists and Pruritus: Review of Current Literature. Dermatol Ther (Heidelb) 2019; 9:391-405. [PMID: 31190215 PMCID: PMC6704190 DOI: 10.1007/s13555-019-0305-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Indexed: 12/13/2022] Open
Abstract
The discovery of the first neurokinin 1 (NK-1) receptor antagonist was a turning point in the prevention of chemotherapy-induced nausea and vomiting. The NK-1 antagonists are a novel class of drugs that possess antidepressant, anxiolytic, and antiemetic properties. Recently, clinicians have also described an anti-itch activity of NK-1 antagonists. We present herein results from currently available data on use of NK-1R antagonists in dermatology. For this purpose, a systemic electronic literature search of the PubMed and CINAHL databases, Cochrane Library, and clinicaltrials.gov website was performed. Based on currently available data, it can be concluded that NK-1 inhibitors show significant antipruritic potential for treatment of chronic pruritus in different dermatological conditions, but further studies are needed to establish the best indications and dosage of these drugs.
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Affiliation(s)
| | - Kamila Jaworecka
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - Adam Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland.
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6
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Kashiwa M, Matsushita R. Comparative Cost-utility Analysis Between Aprepitant- and Fosaprepitant-containing Regimens To Prevent Chemotherapy-induced Nausea and Vomiting in Patients Receiving Highly Emetogenic Chemotherapy in Japan. Clin Ther 2019; 41:929-942. [PMID: 31036286 DOI: 10.1016/j.clinthera.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/29/2019] [Accepted: 03/17/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Clinical trials have shown that the addition of aprepitant (APR) or a phosphorylated prodrug of aprepitant, fosaprepitant (FosAPR) as prophylactic antiemetic therapy consisting of a 5-hydrotryptamine-3 receptor antagonist and dexamethasone is effective in patients receiving highly emetogenic chemotherapy. These combination therapies have been commonly used in Japan. In the present study, we performed a cost-utility analysis of APR and FosAPR in the context of the Japanese medical insurance system, and economic efficiency was compared. METHODS Data from randomized controlled trials that examined the efficacy of APR and FosAPR in the Japanese population were used. A decision tree was constructed to estimate the effectiveness of chemotherapy for 5 days from the day of the treatment and the cost associated with outpatient chemotherapy from the perspective of a payer. Health outcome was expressed in quality-adjusted life-years (QALYs), and costs were estimated based on medical fees and drug prices from 2018. An incremental cost-effectiveness ratio (ICER) was calculated for each regimen containing either APR or FosAPR. The robustness of the model was assessed using 1-way and probabilistic sensitivity analysis. FINDINGS The base-case analysis estimated that the addition of APR or FosAPR would have incremental effects of 0.00166 and 0.00143 QALY and incremental costs of 8305 and 11,348 JPY (74 and 101 USD [1 USD = 112.17 JPY]), resulting in ICERs of 4,992,172 and 7,955,560 JPY/QALY (44,505 and 70,924 USD/QALY), respectively. Sensitivity analysis revealed that the probability of a complete response for delayed chemotherapy-induced nausea and vomiting had the most influence on the ICERs. Reductions in the drug costs of APR and FosAPR also had an effect on the ICERs. According to the probabilistic sensitivity analysis, APR and FosAPR were dominant in terms of cost-effectiveness in 48.7% and 8.55% of cases, respectively. IMPLICATIONS The ICER of outpatient prophylactic antiemetic therapy in patients receiving highly emetogenic chemotherapy was calculated in the context of the Japanese medical insurance system. Assuming the willingness-to-pay of 5,000,000 JPY/QALY based on the calculated ICER, our findings suggest that although the addition of APR is cost-effective, FosAPR is not cost-effective.
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Affiliation(s)
- Munenobu Kashiwa
- Division of Pharmacy, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan; Department of Pharmacy, First Towakai Hospital, Takatsuki, Japan
| | - Ryo Matsushita
- Division of Pharmaceutical Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
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Tsukiyama I, Ando M, Tsukiyama S, Takeuchi M, Ejiri M, Kurose Y, Saito H, Arakawa I, Inoue T, Yamaguchi E, Kubo A. Cost-utility analysis of aprepitant for patients who truly need it in Japan. Support Care Cancer 2019; 27:3749-3758. [PMID: 30710243 DOI: 10.1007/s00520-019-04672-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/21/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Neurokinin-1 receptor antagonist (NK1RA) is recommended to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly or moderately emetogenic chemotherapy (HEC or MEC, respectively). We previously reported that aprepitant, an NK1RA, was needed to control CINV in 43% and 12% of patients who received HEC and MEC, respectively (Support Care Cancer 23:905-912, 2015). To elucidate the cost-effectiveness of aprepitant in these patients, a cost-utility analysis according to the necessity of aprepitant was performed. METHODS A decision-analytic model was developed according to the necessity of aprepitant and CINV responses in both acute and delayed phases of chemotherapy. Probabilities of health states and medical costs were derived from the results of the abovementioned trial. RESULT In patients who received HEC and needed aprepitant, the incremental cost-effectiveness ratio (ICER) with aprepitant, relative to the regimen with no aprepitant, was 7912 US dollars (USD) per quality-adjusted life year (QALY) gained, which was far below the commonly accepted threshold of 50,000 USD/QALY. The ICER was 27,457 USD/QALY in patients who received MEC and needed aprepitant. In contrast, in patients who received HEC or MEC but did not need aprepitant, the ICER was 175,959 or 478,844 USD/QALY, respectively. CONCLUSION Regardless of whether a patient received HEC or MEC, aprepitant use was highly cost-effective for patients who truly needed it. These results warrant further research to predict the necessity of NK1RA treatment before initiating emetogenic chemotherapies.
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Affiliation(s)
- Ikuto Tsukiyama
- Faculty of Pharmacy, Meijo University, Nagoya, Japan
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Masahiko Ando
- Center for Advanced Medical and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Sumiyo Tsukiyama
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Masayuki Takeuchi
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Masayuki Ejiri
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Yusuke Kurose
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Hiroko Saito
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Ichiro Arakawa
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan
| | - Tadao Inoue
- School of Pharmaceutical Sciences, Ohu University, Koriyama, Japan
| | - Etsuro Yamaguchi
- Division of Respiratory Medicine and Allergology, School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Akihito Kubo
- Division of Respiratory Medicine and Allergology, School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
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Shimizu H, Suzuki K, Uchikura T, Tsuji D, Yamanaka T, Hashimoto H, Goto K, Matsui R, Seki N, Shimada T, Ikeda S, Ikegami N, Hama T, Yamamoto N, Sasaki T. Economic analysis of palonosetron versus granisetron in the standard triplet regimen for preventing chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy in Japan (TRIPLE phase III trial). J Pharm Health Care Sci 2018; 4:31. [PMID: 30555710 PMCID: PMC6287343 DOI: 10.1186/s40780-018-0128-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/14/2018] [Indexed: 11/25/2022] Open
Abstract
Background We conducted an economic assessment using test data from the phase III TRIPLE study, which examined the efficacy of a 5-hydroxytryptamine 3 receptor antagonist as part of a standard triplet antiemetic regimen including aprepitant and dexamethasone in preventing chemotherapy-induced nausea and vomiting in patients receiving cisplatin-based highly emetogenic chemotherapy (HEC). Methods We retrospectively investigated all medicines prescribed for antiemetic purposes within 120 h after the initiation of cisplatin administration during hospitalization. In the TRIPLE study, patients were assigned to treatment with granisetron (GRA) 1 mg (n = 413) or palonosetron (PALO) 0.75 mg (n = 414). The evaluation measure was the cost-effectiveness ratio (CER) assessed as the cost per complete response (CR; no vomiting/retching and no rescue medication). The analysis was conducted from the public healthcare payer’s perspective. Results The CR rates were 59.1% in the GRA group and 65.7% in the PALO group (P = 0.0539), and the total frequencies of rescue medication use for these groups were 717 (153/413 patients) and 573 (123/414 patients), respectively. In both groups, drugs with antidopaminergic effects were chosen as rescue medication in 86% of patients. The costs of including GRA and PALO in the standard triplet antiemetic regimen were 15,342.8 and 27,863.8 Japanese yen (JPY), respectively. In addition, the total costs of rescue medication use were 73,883.8 (range, 71,106.4–79,017.1) JPY for the GRA group and 59,292.7 (range, 57,707.5–60,972.8) JPY for the PALO group. The CERs (JPY/CR) were 26,263.4 and 42,628.6 for the GRA and PALO groups, respectively, and the incremental cost-effectiveness ratio (ICER) between the groups was 189,171.6 (189,044.8–189,215.5) JPY/CR. Conclusions We found that PALO was more expensive than GRA in patients who received a cisplatin-based HEC regimen. Electronic supplementary material The online version of this article (10.1186/s40780-018-0128-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hisanori Shimizu
- 1Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan.,13Department of Pharmacy Services, Showa University Hospital, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Kenichi Suzuki
- 2Department of Pharmacy, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Takeshi Uchikura
- 1Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Daiki Tsuji
- 3Department of Clinical Pharmacology & Genetics, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Takeharu Yamanaka
- 4Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | | | - Koichi Goto
- 6Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Reiko Matsui
- 7Departments of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nobuhiko Seki
- 8Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Toshikazu Shimada
- 9Center for Clinical Reseach&Trial, Teikyo University Hospital, Tokyo, Japan
| | - Shunya Ikeda
- 10Department of Public Health, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Naoki Ikegami
- 11Graduate School of Public Health, St Lukes International University, Tokyo, Japan
| | - Toshihiro Hama
- 2Department of Pharmacy, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Nobuyuki Yamamoto
- 12Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tadanori Sasaki
- 1Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
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9
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Tsukiyama I, Hasegawa S, Ikeda Y, Takeuchi M, Tsukiyama S, Kurose Y, Ejiri M, Sakuma M, Saito H, Arakawa I, Inoue T, Yamaguchi E, Kubo A. Cost-effectiveness of aprepitant in Japanese patients treated with cisplatin-containing highly emetogenic chemotherapy. Cancer Sci 2018; 109:2881-2888. [PMID: 29999572 PMCID: PMC6125450 DOI: 10.1111/cas.13736] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/07/2018] [Indexed: 11/30/2022] Open
Abstract
Chemotherapy‐induced nausea and vomiting (CINV) remains a major adverse event in cancer chemotherapy. Although aprepitant is effective in preventing CINV, an increment in financial burden for uniform use of aprepitant is a concern. The aim of the present study was to define the cost‐effectiveness of aprepitant from the perspective of the Japanese National Health Insurance system. Based on the results of a randomized phase II trial comparing an aprepitant‐containing regimen versus a nonaprepitant regimen in Japanese patients who received cisplatin‐containing highly emetogenic chemotherapy, a decision analytic model was developed. The incremental cost‐effectiveness ratio (ICER) was calculated both in the outpatient care setting (OCS) and in the inpatient care setting (ICS). The use of the aprepitant‐containing regimen was associated with improved quality of life compared with the nonaprepitant regimen, with an increment in quality‐adjusted life years (QALY) of 0.0016. The incremental total medical costs associated with the use of the aprepitant regimen were lower in the OCS than in the ICS, 6192 JPY (56.92 USD) and 9820 JPY (90.27 USD), respectively. The ICER was calculated as 3 906 698 JPY (35 910 USD) per QALY gained in the OCS and 6 195 781 JPY (56 952 USD) per QALY gained in the ICS. Cost‐effectiveness of the aprepitant‐containing antiemetic therapy was limited to the OCS, considering the threshold of willingness‐to‐pay commonly accepted (5 million JPY [45 960 USD] in Japan and 50 000 USD in the USA). The efficacy of aprepitant offsets the costs for revisiting clinics or rehospitalization added with rescue medications in the OCS.
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Affiliation(s)
- Ikuto Tsukiyama
- Faculty of Pharmacy, Meijo University, Nagoya, Japan.,Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | | | - Yoshiaki Ikeda
- School of Pharmacy, Kinjo Gakuin University, Nagoya, Japan
| | - Masayuki Takeuchi
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Sumiyo Tsukiyama
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yusuke Kurose
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masayuki Ejiri
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masaki Sakuma
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiroko Saito
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Ichiro Arakawa
- Faculty of Pharmacy, Teikyo Heisei University, Chiba, Japan
| | - Tadao Inoue
- Faculty of Pharmacy, Ohu University, Koriyama, Japan
| | - Etsuro Yamaguchi
- Department of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Akihito Kubo
- Department of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine, Nagakute, Japan
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Chan A, Abdullah MM, Ishak WZBW, Ong-Cornel AB, Villalon AH, Kanesvaran R. Applicability of the National Comprehensive Cancer Network/Multinational Association of Supportive Care in Cancer Guidelines for Prevention and Management of Chemotherapy-Induced Nausea and Vomiting in Southeast Asia: A Consensus Statement. J Glob Oncol 2017; 3:801-813. [PMID: 29244998 PMCID: PMC5735961 DOI: 10.1200/jgo.2016.005728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A meeting of regional experts was convened in Manila, Philippines, to develop a resource-stratified chemotherapy-induced nausea and vomiting (CINV) management guideline. In patients treated with highly emetogenic chemotherapy in general clinical settings, triple therapy with a serotonin (5-hydroxytryptamine-3 [5-HT3]) antagonist (preferably palonosetron), dexamethasone, and aprepitant is recommended for acute CINV prevention. In resource-restricted settings, triple therapy is still recommended, although a 5-HT3 antagonist other than palonosetron may be used. In both general and resource-restricted settings, dual therapy with dexamethasone (days 2 to 4) and aprepitant (days 2 to 3) is recommended to prevent delayed CINV. In patients treated with moderately emetogenic chemotherapy, dual therapy with a 5-HT3 antagonist, preferably palonosetron, and dexamethasone is recommended for acute CINV prevention in general settings; any 5-HT3 antagonist can be combined with dexamethasone in resource-restricted environments. In general settings, for the prevention of delayed CINV associated with moderately emetogenic chemotherapy, corticosteroid monotherapy on days 2 and 3 is recommended. If aprepitant is used on day 1, it should be continued on days 2 and 3. Prevention of delayed CINV with corticosteroids is preferred in resource-restricted settings. The expert panel also developed CINV management guidelines for anthracycline plus cyclophosphamide combination schedules, multiday cisplatin, and chemotherapy with low or minimal emetogenic potential, and its recommendations are detailed in this review. Overall, these regional guidelines provide definitive guidance for CINV management in general and resource-restricted settings. These consensus recommendations are anticipated to contribute to collaborative efforts to improve CINV management in Southeast Asia.
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Affiliation(s)
- Alexandre Chan
- Alexandre Chan, National University of Singapore; Ravindran Kanesvaran, National Cancer Centre Singapore, Singapore; Matin M. Abdullah, Subang Jaya Medical Centre, Selangor; Wan Zamaniah B. Wan Ishak, University of Malaya, Kuala Lumpur, Malaysia; Annielyn B. Ong-Cornel, University of Perpetual Help DALTA Medical Center, Las Piñas City; and Antonio H. Villalon, Manila Doctors Hospital, Manila, Philippines
| | - Matin M. Abdullah
- Alexandre Chan, National University of Singapore; Ravindran Kanesvaran, National Cancer Centre Singapore, Singapore; Matin M. Abdullah, Subang Jaya Medical Centre, Selangor; Wan Zamaniah B. Wan Ishak, University of Malaya, Kuala Lumpur, Malaysia; Annielyn B. Ong-Cornel, University of Perpetual Help DALTA Medical Center, Las Piñas City; and Antonio H. Villalon, Manila Doctors Hospital, Manila, Philippines
| | - Wan Zamaniah B. Wan Ishak
- Alexandre Chan, National University of Singapore; Ravindran Kanesvaran, National Cancer Centre Singapore, Singapore; Matin M. Abdullah, Subang Jaya Medical Centre, Selangor; Wan Zamaniah B. Wan Ishak, University of Malaya, Kuala Lumpur, Malaysia; Annielyn B. Ong-Cornel, University of Perpetual Help DALTA Medical Center, Las Piñas City; and Antonio H. Villalon, Manila Doctors Hospital, Manila, Philippines
| | - Annielyn B. Ong-Cornel
- Alexandre Chan, National University of Singapore; Ravindran Kanesvaran, National Cancer Centre Singapore, Singapore; Matin M. Abdullah, Subang Jaya Medical Centre, Selangor; Wan Zamaniah B. Wan Ishak, University of Malaya, Kuala Lumpur, Malaysia; Annielyn B. Ong-Cornel, University of Perpetual Help DALTA Medical Center, Las Piñas City; and Antonio H. Villalon, Manila Doctors Hospital, Manila, Philippines
| | - Antonio H. Villalon
- Alexandre Chan, National University of Singapore; Ravindran Kanesvaran, National Cancer Centre Singapore, Singapore; Matin M. Abdullah, Subang Jaya Medical Centre, Selangor; Wan Zamaniah B. Wan Ishak, University of Malaya, Kuala Lumpur, Malaysia; Annielyn B. Ong-Cornel, University of Perpetual Help DALTA Medical Center, Las Piñas City; and Antonio H. Villalon, Manila Doctors Hospital, Manila, Philippines
| | - Ravindran Kanesvaran
- Alexandre Chan, National University of Singapore; Ravindran Kanesvaran, National Cancer Centre Singapore, Singapore; Matin M. Abdullah, Subang Jaya Medical Centre, Selangor; Wan Zamaniah B. Wan Ishak, University of Malaya, Kuala Lumpur, Malaysia; Annielyn B. Ong-Cornel, University of Perpetual Help DALTA Medical Center, Las Piñas City; and Antonio H. Villalon, Manila Doctors Hospital, Manila, Philippines
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Phase II open label pilot trial of aprepitant and palonosetron for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderately emetogenic FOLFOX chemotherapy for the treatment of colorectal cancer. Support Care Cancer 2017; 26:1273-1279. [PMID: 29090385 DOI: 10.1007/s00520-017-3950-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting (CINV) causes significant morbidity among colorectal cancer patients, receiving fluorouracil, oxaliplatin, and leucovorin (FOLFOX) chemotherapy even with standard antiemetic prophylaxis. The purpose of this study is to determine if the addition of aprepitant to standard antiemetic therapy improves CINV in these patients. METHODS Patients receiving FOLFOX for colorectal cancer were given antiemetic prophylaxis with aprepitant 125 mg orally on day 1 and 80 mg on days 2 and 3. Palonosetron 0.25 mg was given IV push on day 1 only. Dexamethasone 12 mg was administered orally on day 1 and 8 mg each morning on days 2 through 4. Assessments including emetic events, rescue doses, nutritional intake, and appetite were recorded in a patient diary which was returned to study personnel in the following cycle. RESULTS Of the 53 patients screened, 50 were evaluable and had a complete dataset for cycle 1. For the first cycle, 74% of patients achieved a complete response (CR), 22% achieved a major response and 4% experienced treatment failure. The percentage of patients achieving a CR remained high throughout each cycle at 83, 83, and 86% for cycles 2, 3, and 4, respectively. Appetite and nutritional status remained largely unchanged throughout treatment. Adverse events occurring in more than 10% of patients included diarrhea (13.6%), fatigue (12.6%), and neutropenia (11%). CONCLUSIONS Aprepitant added to standard antiemetic therapy appears to be an effective and safe regimen for prevention of CINV in patients receiving FOLFOX.
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Aprepitant for the Treatment of Chronic Refractory Pruritus. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4790810. [PMID: 29057261 PMCID: PMC5625747 DOI: 10.1155/2017/4790810] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/20/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022]
Abstract
Chronic pruritus is a difficult condition to treat and is associated with several comorbidities, including insomnia, depression, and decreased quality of life. Treatment for chronic itch includes corticosteroids, antihistamines, and systemic therapies such as naltrexone, gabapentin, UV light therapy, and immunomodulatory treatments, including azathioprine, methotrexate, and cellcept. However, some patients still remain refractory to conventional therapy. Aprepitant is a neurokinin-1 receptor antagonist approved for the prevention of chemotherapy-induced and postoperative nausea and vomiting (CINV, PONV). Recently, aprepitant has demonstrated effectiveness in several case series and open label trials in relieving pruritus for patients refractory to other treatments. Patients with pruritus associated with Sézary syndrome, mycosis fungoides, lung adenocarcinoma, breast carcinoma, sarcomas, metastatic solid tumors, chronic kidney disease, hyperuricemia, iron deficiency, brachioradial pruritus, and Hodgkin's lymphoma have experienced considerable symptom relief with short-term use of aprepitant (up to two weeks). Due to differences in reporting and evaluation of drug effects, the mechanism of aprepitant's role is difficult to understand based on the current literature. Herein, we evaluate aprepitant's antipruritic effects and discuss its mechanism of action and adverse effects. We propose that aprepitant is an alternative for patients suffering from pruritus who do not obtain enough symptom relief from conventional therapy.
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Thavorn K, Coyle D, Hoch JS, Vandermeer L, Mazzarello S, Wang Z, Dranitsaris G, Fergusson D, Clemons M. A cost-utility analysis of risk model-guided versus physician’s choice antiemetic prophylaxis in patients receiving chemotherapy for early-stage breast cancer: a net benefit regression approach. Support Care Cancer 2017; 25:2505-2513. [DOI: 10.1007/s00520-017-3658-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
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Ma H, Jian W, Xu T, He Y, Rizzo JA, Fang H. Quality of pharmacoeconomic research in China: A systematic review. Medicine (Baltimore) 2016; 95:e5114. [PMID: 27741131 PMCID: PMC5072958 DOI: 10.1097/md.0000000000005114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/12/2016] [Accepted: 09/18/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The number of pharmacoeconomic publications in the literature from China has risen rapidly, but the quality of pharmacoeconomic publications from China has not been analyzed. OBJECTIVES This study aims to identify all recent pharmacoeconomic publications from China, to critically appraise the reporting quality, and to summarize the results. METHODS Four databases (PubMed, Web of Science, Medline, and EmBase) were searched for original articles published up to December 31, 2014. The Consolidated Health Economic Evaluation Reporting Standards statement including 24 items was used to assess the quality of reporting of these articles. RESULTS Of 1046 articles identified, 32 studies fulfilled the inclusion criteria. They were published in 23 different journals. Quality of reporting varied between studies, with an average score of 18.7 (SD = 4.33) out of 24 (range 9-23.5). There was an increasing trend of pharmacoeconomic publications and reporting quality over years from 2003 to 2014. According to the Consolidated Health Economic Evaluation Reporting Standards, the reporting quality for the items including "title," "comparators of method," and "measurement of effectiveness" are quite low, with less than 50% of studies fully satisfying these reporting standards. In contrast, reporting was good for the items including "introduction," "study perspective," "choice of health outcomes," "study parameters," "characterizing heterogeneity," and "discussion," with more than 75% of the articles satisfying these reporting criteria. The remaining items fell in between these 2 extremes, with 50% to 75% of studies satisfying these criteria. CONCLUSION Our study suggests the need for improvement in a number of reporting criteria. But the criteria for which reporting quality was low seem to be limitations that would be straightforward to correct in future studies.
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Affiliation(s)
- Huifen Ma
- China Center for Health Development Studies, Peking University
| | - Weiyan Jian
- Department of Health Policy and Administration, Peking University, Haidian District, Beijing, China
| | - Tingting Xu
- China Center for Health Development Studies, Peking University
| | - Yasheng He
- China Center for Health Development Studies, Peking University
| | - John A. Rizzo
- Departments of Economics and Department of Preventive Medicine, State University of New York at Stony Brook, Stony Brook, NY
| | - Hai Fang
- China Center for Health Development Studies, Peking University
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Sommariva S, Pongiglione B, Tarricone R. Impact of chemotherapy-induced nausea and vomiting on health-related quality of life and resource utilization: A systematic review. Crit Rev Oncol Hematol 2016; 99:13-36. [DOI: 10.1016/j.critrevonc.2015.12.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/01/2015] [Accepted: 12/01/2015] [Indexed: 11/25/2022] Open
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16
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Cost-consequence analysis of aprepitant compared to standard therapy (5-HT
3
+ corticosteroids) for the prevention of highly emetogenic chemotherapy-induced nausea and vomit. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2015. [DOI: 10.5301/grhta.5000195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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