Abstract
BackgroundWe 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).MethodsWe 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.ResultsThe 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.ConclusionsWe found that PALO was more expensive than GRA in patients who received a cisplatin-based HEC regimen.
Highlights
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)
We found that PALO was more expensive than GRA in patients who received a cisplatin-based HEC regimen
Current antiemetic guidelines recommend a three-drug combination consisting of a 5-hydroxytryptamine 3 (5-HT3) receptor antagonists (RAs), dexamethasone (DEX), and APR for patients receiving highly emetogenic chemotherapy (HEC) [9,10,11]
Summary
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). Patients In total, 827 patients receiving cisplatin-based HEC enrolled in a randomized, double-blind, multicenter phase III trial to validate the superiority of PALO (0.75 mg) over GRA (1 mg) were evaluated. The study design details and primary results of our phase III trial were described previously [16]. This study was conducted in accordance with the Japanese Ethical Guidelines for Medical and Health Research Involving Human Subjects. In addition to the economic analysis of data from our phase III trial, we investigated and analyzed medical expenses based on data for receipt information during hospitalization in the Cancer Institute Hospital of the Japanese Foundation for Cancer Research after receiving approval from the clinical research ethics review committee. The inclusion and exclusion criteria were described previously [16]
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