Cost‐effectiveness of aprepitant in Japanese patients treated with cisplatin‐containing highly emetogenic chemotherapy

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.

The Antiemetic Effect of Xiao‐Ban‐Xia‐Tang Formula against Cisplatin‐Induced Emesis is Mediated through Inhibition of NLRP3 Inflammasome Activation in a Rat Pica Model

“…Although cisplatin is the most commonly used antineoplastic drugs in the treatment of many patients with solid organ cancer, it has strong side effects on the gastrointestinal tract [49]. As reported previously, cisplatin at a dose of 6 mg/ kg induced pica within 8 hours after administration of the drug, and these behaviors continued for 5 days [35].…”

Cost-utility analysis of olanzapine in four-drug antiemetic therapy in Japanese patients treated with highly emetogenic cisplatin-containing chemotherapy

“…Kashiwa et al reported the cost-effectiveness of palonosetron in cisplatin-containing HEC regimens based on the TRIPLE study results conducted in Japan [13,21] [12].…”

“…According to previous reports, we simulated model patients treated with highly emetogenic cisplatincontaining chemotherapy and developed a decision-analytic model (Fig. 1) [12][13][14][15][16]. Based on a phase III clinical trial conducted in Japan (J-FORCE study) [7], the model patients received either a four-drug or a three-drug regimen.…”

“…Because NK 1 receptor antagonists, such as aprepitant and 5-HT 3 receptor antagonists, are more expensive than classical antiemetics, several studies have examined their costeffectiveness in Japan and overseas [12][13][14][15][16]. In Japan, aprepitant use was reportedly cost-effective for outpatient treatment but not cost-effective under inpatient conditions [12]. Palonosetron, a secondgeneration 5-HT 3 receptor antagonist, was reportedly not cost-effective as a rst-generation 5-HT 3 receptor antagonist [13].…”

Cost-utility analysis of palonosetron in the antiemetic regimen for cisplatin-containing highly emetogenic chemotherapy in Japan

“…Sun et al report a QoL evaluation using a visual analog scale according to the presence or absence of CINV by chemotherapy [20]. Including this report, according to previous CINV reports [13, 14, 21, 22], utility values were applied to the three health states. The following utility values were defined: 0.9 for CP with no significant nausea or vomiting; 0.2 for IR with nausea and vomiting; and 0.7 for CRB without vomiting or use of rescue medication.…”