Cost-effectiveness of Prophylactic Antiemetic Therapy with Ondansetron, Droperidol, or Placebo

Hill, Robert P.; Lubarsky, David A.; Phillips-Bute, Barbara; Fortney, Jennifer T.; Creed, Mary R.; Glass, Peter S. A.; Gan, Tong J.

doi:10.1097/00000542-200004000-00012

Cited by 311 publications

(170 citation statements)

References 2 publications

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“…The cost of treating vomiting was three times more than the cost of treating nausea. 59 Similar results were reported in another study where both droperidol and dolasetron were more cost-effective than no prophylaxis in high-risk patients. 133 In two separate cost-effectiveness analyses, Tang et al and Hill et al reported that droperidol was more cost-effective than ondansetron for PONV prophylaxis.…”

Section: Combination Antiemetic Therapy and Multimodal Approachsupporting

confidence: 85%

“…In a dose of 1.25 mg, it was more cost-effective than ondansetron 4 mg and was recommended as a first line agent for PONV prophylaxis (IA). 59 The NNT to prevent early nausea was 5. For both early and late vomiting, the best efficacy was with 1.5 to 2.5 mg (NNT = 7).…”

Section: Older Generation Antiemeticsmentioning

confidence: 99%

“…133 In two separate cost-effectiveness analyses, Tang et al and Hill et al reported that droperidol was more cost-effective than ondansetron for PONV prophylaxis. 59,134 Watcha and Smith determined that prophylaxis was only cost-effective if the incidence of PONV exceeded 33% with ondansetron and 13% with droperidol. 135 Since the different 5-HT 3 receptor antagonists have comparable efficacy and safety profiles, it was determined that acquisition cost was the main factor that differentiated the 5-HT 3 compounds from one another.…”

Section: Combination Antiemetic Therapy and Multimodal Approachmentioning

confidence: 99%

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Evidence-based management of postoperative nausea and vomiting: a review

Habib

Gan

2004

Can J Anesth/J Can Anesth

196

106

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P Pu ur rp po os se e: : To provide evidence-based guidelines for the prophylaxis and treatment of postoperative nausea and vomiting (PONV).S So ou ur rc ce e: : Literature from randomized controlled trials, systematic reviews, logistic regression analyses and expert opinion in the management of PONV.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The etiology of PONV is multifactorial. Patient, anesthesia, and surgery related risk factors have been identified. Universal PONV prophylaxis is not cost-effective. Identification of patients at high-risk of PONV allows targeting prophylaxis to those who will benefit most from it. No prophylaxis is needed for patients at low risk for PONV. For patients at moderate risk for PONV, prophylaxis using a single antiemetic or a combination of two agents should be considered. Double and triple antiemetic combinations should be considered for patients at high risk for PONV. Furthermore, a multimodal approach should be adopted incorporating steps to keep the baseline risk of PONV low. The optimum cost-effective approach to the management of PONV will differ between an ambulatory centre and an inpatient hospital setting. For the treatment of established PONV in patients who failed prophylaxis, patients should not receive a repeat dose of the prophylactic antiemetic. Rather, a drug acting at a different receptor should be used. Beyond six hours after surgery, patients can be treated with any of the agents used for prophylaxis, except dexamethasone and transdermal scopolamine.C Co on nc cl lu us si io on n: : PONV are common after anesthesia and surgery. We provided evidence-based guidelines for the management of this problem based on the available literature. Objectif : Énoncer des lignes de conduite fondées sur des données probantes pour la prévention et le traitement des nausées et des vomissements postopératoires (NVPO). Source : Les publications d'essais contrôlés et randomisés, les études méthodiques, les analyses de régression logistique et l'opinion d'experts sur le traitement des NVPO. Constatations principales : L'origine des NVPO est multifactorielle. Les facteurs de risque reliés au patient, à l'anesthésie et au type de chirurgie sont connus. La prévention universelle des NVPO n'est pas rentable. L'identification des patients à haut risque de NVPO permet

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Section: Combination Antiemetic Therapy and Multimodal Approachsupporting

confidence: 85%

Section: Older Generation Antiemeticsmentioning

confidence: 99%

Section: Combination Antiemetic Therapy and Multimodal Approachmentioning

confidence: 99%

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Evidence-based management of postoperative nausea and vomiting: a review

Habib

Gan

2004

Can J Anesth/J Can Anesth

196

106

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“…Os escores preditivos de Apfel são fáceis de aplicar, apresentando uma razoável preditibilidade sobre NVPO, e simultaneamente permitem a comparação entre vários grupos no domínio da investigação clinica de antieméticos. Alguns autores criticaram Apfel pela dificuldade de aplicar alguns dos seus fatores de risco 20 22 . Na conferência de consenso de 2003 foi recomendada profilaxia a pacientes com risco moderado a elevado para NVPO ou para aqueles com potencial morbidade associada a NVPO, especificamente deiscência de suturas, rotura esofágica, formação de hematoma e pneumonia aspirativa 21 .…”

Section: Identificação De Fatores De Risco Para Nvpounclassified

Náuseas e vômitos no pós-operatório: uma revisão do "pequeno-grande" problema

Lages¹,

Fonseca²,

Neves³

et al. 2005

Rev. Bras. Anestesiol.

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“…Additionally, persistent nausea and vomiting can delay discharge from hospital (1,2). Breast surgery is associated with a high (40% to 70%) incidence of PONV (3,4).…”

Section: La Dexaméthasone Intraveineuse Permet-elle De Prévenir Les Nmentioning

confidence: 99%