Cost-effectiveness of an aprepitant regimen for prevention of chemotherapy-induced nausea and vomiting in patients with breast cancer in the UK

Abstract

PurposePrevention of chemotherapy-induced nausea and vomiting (CINV) remains an important goal for patients receiving chemotherapy. The objective of this study was to define, from the UK payer perspective, the cost-effectiveness of an antiemetic regimen using aprepitant, a selective neurokinin-1 receptor antagonist, for patients receiving chemotherapy for breast cancer.MethodsA decision-analytic model was developed to compare an aprepitant regimen (aprepitant, ondansetron, and dexamethasone) with a standard UK antiemetic regimen (ondansetron, dexamethasone, and metoclopramide) for expected costs and health outcomes after single-day adjuvant chemotherapy for breast cancer. The model was populated with results from patients with breast cancer participating in a randomized trial of CINV preventative therapy for cycle 1 of single-day chemotherapy.ResultsDuring 5 days after chemotherapy, 64% of patients receiving the aprepitant regimen and 47% of those receiving the UK comparator regimen had a complete response to antiemetic therapy (no emesis and no rescue antiemetic therapy). A mean of £37.11 (78%) of the cost of aprepitant was offset by reduced health care resource utilization costs. The predicted gain in quality-adjusted lifeyears (QALYs) with the aprepitant regimen was 0.0048. The incremental cost effectiveness ratio (ICER) with aprepitant, relative to the UK comparator, was £10,847/QALY, which is well below the threshold commonly accepted in the UK of £20,000–£30,000/QALY.ConclusionThe results of this study suggest that aprepitant is cost-effective for preventing CINV associated with chemotherapy for patients with breast cancer in the UK health care setting.

Cost-Effectiveness Analysis of Granisetron-Based versus Standard Antiemetic Regimens in Low-Emetogenic Chemotherapy: A Hospital-based Perspective from Malaysia

“…This was mainly attributable to the high differential cost between the original granisetron (Kytril ® ) and generic metoclopramide or dexamethasone marketed in Malaysia. Unlike most of the previous pharmacoeconomic studies of antiemetics in chemotherapy which had favored the new treatment (Cox and Hirsch, 1993;Cunningham et al, 1993;Lordick et al, 2007;Lopes et al, 2012;Humphreys et al, 2013), our results had indicated a high ICER (MYR 430.66 per successfully treated patient) of granisetron-based regimen relative to standard regimen. To date, Malaysia does not have a published threshold to determine costeffectiveness of antiemetics.…”

Clinical Impact of Aprepitant in Patients Receiving High-Dose Chemotherapy prior to Autologous Peripheral Blood Stem Cell Transplantation: A Cost-Effectiveness Analysis

“…However, the cost benefit of aprepitant was not evaluated in those reports. All previous studies that evaluated the cost-effectiveness of aprepitant for CINV in patients receiving chemotherapy, except for HDCT regimens, employed a decision tree model [24][25][26] , and the reasons for the cost benefit were therefore unclear. In our study, cost-effectiveness was analyzed using the direct medical costs.…”

“…In addition, other studies suggested that aprepitant use with chemotherapy regimens was cost-effective [24][25][26] . However, the economic benefit of aprepitant use has not been elucidated in patients receiving HDCT prior to APBSCT.…”

NK-1 Receptor Antagonists: Who Truly Need them and their Cost-Effectiveness Analysis?

“…To date, six studies have compared the cost-effectiveness ratio of antiemetic regimens consisting of aprepitant, a 5-HT3RA, and a corticosteroid with that of a conventional regimen comprising a 5-HT3RA and a corticosteroid for CINV prevention in HEC and in anthracyclines plus cyclophosphamide therapy [7][8][9][11][12][13]. Based on the data from published phase III trials of aprepitant [15,16,[18][19][20], these studies calculated the incremental cost-effectiveness ratio (ICER), which is a ratio of the incremental cost per quality adjusted life years (QALY), as the primary index of cost-effectiveness in a putative setting according to each country's economic status.…”

“…The cost-effectiveness analyses of NK-1RAs reported to date are all from the perspective of the payer or healthcare system, and outcomes were measured using CINV-related health status (i.e., rates of CP, CR, and IR) [7][8][9][11][12][13]. Regarding medical costs of CINV, all of these reports included only direct medical costs of CINV, and did not analyze indirect costs.…”