PDG5 Cost- Effectiveness Analysis between Aprepitant and Fosaprepitant in the Prevention of Chemotherapy-Induced Nausea and Vomiting in China

Abstract

The one of important goals for cancer patients receiving chemotherapy is to prevent the chemotherapy-induced nausea and vomiting (CINV) cost-effectively. Although some medicines are effective in preventing CINV, the drug expenditures raises concern regarding incremental financial burden of patients. Our purpose is to evaluate the cost-effectiveness of aprepitant (APR)- and fosaprepitant (FosAPR)-containing regimens for the prevention of CINV among patients receiving high emetogenic chemotherapy from the Chinese payer perspective. A decision tree model was established to measure the five-day costs and health outcomes between APR-containing regimen ( aprepitant, palonosetron and dexamethasone) and FosAPR-containing regimen (fosaprepitant, palonosetron and dexamethasone). Clinical data was derived from a randomized, double-blind controlled trail on Chinese inpatients who received high emetogenic chemotherapy. All medical costs were calculated in RMB from the perspective of Chinese health system. 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. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to test the robustness of the model. Compared with APR, FosAPR had a mean health-care savings of ￥121.56 but had 0.0001815 QALY less than APR, resulting in ICER of ￥669926.19 per QALY. One-way 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 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 ￥198,018. FosAPR had the same treatment effect with APR but was cost-effective in China at the current WTP threshold. Only if the threshold went to more than ￥600,000,aprepitant might be cost-effective.