Real-world antiemetic utilization in patients undergoing carboplatin chemotherapy.

Abstract

10 Background: More than 70% of patients receiving chemotherapy will experience chemotherapy-induced nausea and vomiting (CINV). Chemotherapeutic regimens (regimens) are classified as highly emetogenic, moderately emetogenic, low potential, or minimal risk for emesis. The NCCN has recently reclassified carboplatin emetogenicity according to the AUC (target area under the concentration versus time curve) with a carboplatin AUC ≥4 classified as highly emetogenic and carboplatin AUC < 4 as moderately emetogenic - but highly emetogenic in certain patients. This study assessed use of anti-emetic agents in carboplatin based regimens. Methods: This study consisted of a retrospective analysis of administrative claims data from multiple commercial health plans. Claims from 1/1/2010-10/31/2017 were analyzed. Index date for each patient was the first medical claim of the regimen of interest. Included patients had ≥1 medical claim for the selected regimen and were eligible for both medical and pharmacy benefits for ≥6 months prior to, and 12 months post index date. CINV-related hospitalizations and ER cost and utilization were assessed for patients treated with carboplatin based regimens. Results: In total, 4,430 mostly female (74%) patients met criteria for treatment with a carboplatin-based index regimen. Between 2010 and 2017, the following trends were noted in the study population: Adherence to NCCN recommended 3 drug CINV prophylaxis (triplet therapy) ranged from about 23% to 35%. The rate of CINV related emergency department (ED) visits was 5.3% and the overall rate of CINV related inpatient visits was 0.11%. The average cost for CINV related hospitalization for a carboplatin patient was $8,562 (SD 6,207) with an average LOS of 3.1 days. ED visits that were CINV related cost $2,463 on average (SD 3,054). Conclusions: Guidelines recommend use of up to three agents in the prevention of chemotherapy induced nausea and vomiting. Use of a triplet therapy for CINV prophylaxis in carboplatin based highly emetogenic regimens has increased over time in the plans analyzed and may offer an opportunity to reduce rate of CINV related hospitalizations and ED visits, as well as associated costs.