Cost-utility and budget impact analyses of the use of NEPA for chemotherapy-induced nausea and vomiting prophylaxis in Italy

Restelli, Umberto; Saibene, G.; Nardulli, Patrizia; Turi, Roberta Di; Bonizzoni, Erminio; Scolari, Francesca; Perrone, Tania; Croce, Davide; Celio, Luigi

doi:10.1136/bmjopen-2016-015645

Cited by 15 publications

(32 citation statements)

References 29 publications

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“…Restelli et al evaluated the incremental cost-utility from the Italian healthcare perspective of NEPA versus APR plus PALO, fosaprepitant (fAPR) plus PALO, APR plus ondansetron (ONDA), and fAPR plus ONDA in patients receiving HEC. Compared to all four comparator regimens, NEPA resulted in decreased incremental medical cost (€30-€71) and increased incremental QALDs (0.08-0.26) in HEC patients [32]. Similarly, from a British healthcare perspective, NEPA was the dominant strategy in HEC patients, resulting in a reduction of costs and a gain of QALDs versus APR + PALO [20].…”

Section: Discussionmentioning

confidence: 92%

Cost-effectiveness of a fixed combination of netupitant and palonosetron (NEPA) relative to aprepitant plus granisetron (APR + GRAN) for prophylaxis of chemotherapy-induced nausea and vomiting (CINV): a trial-based analysis

Botteman

Nickel²,

Corman

et al. 2019

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Purpose To assess, from a United States (US) perspective, the cost-effectiveness of chemotherapy-induced nausea and vomiting (CINV) prophylaxis using a single dose of netupitant and palonosetron in a fixed combination (NEPA) versus aprepitant plus granisetron (APR + GRAN), each in combination with dexamethasone, in chemotherapy-naïve patients receiving highly emetogenic chemotherapy (HEC). Methods We analyzed patient-level outcomes over a 5-day post-HEC period from a randomized, double-blind, phase 3 clinical trial of NEPA (n = 412) versus APR + GRAN (n = 416). Costs and CINV-related utilities were assigned to each subject using published sources. Parameter uncertainty was addressed via multivariate probabilistic sensitivity analyses (PSA). Results Compared to APR + GRAN, NEPA resulted in a gain of 0.09 quality-adjusted life-days (QALDs) (4.04 vs 3.95; 95% CI −0.06 to 0.25

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Section: Discussionmentioning

confidence: 92%

Cost-effectiveness of a fixed combination of netupitant and palonosetron (NEPA) relative to aprepitant plus granisetron (APR + GRAN) for prophylaxis of chemotherapy-induced nausea and vomiting (CINV): a trial-based analysis

Botteman

Nickel²,

Corman

et al. 2019

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“…Restelli et al reported the cost-effectiveness of NEPA, comparing the combination with NK1-RA (APR or fosaprepitant) and 5-HT3RA (PALO or ondansetron) in patients receiving highly or moderately emetogenic chemotherapy using a Markov model in the Italian medical care system. The results showed that NEPA was more effective and less expensive [28]. The present study compared a triplet regimen of APR, DEX, and PALO against a control of APR, DEX, and GRA in the Japanese medical care system.…”

Section: Discussionmentioning

confidence: 99%

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

Kashiwa

Matsushita

2019

BMC Health Serv Res

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Background An antiemetic triplet regimen of 5-hydrotryptamine-3 receptor antagonist, dexamethasone, and aprepitant is the standard prophylaxis with highly emetogenic chemotherapy (HEC). A randomized phase III trial comparing palonosetron (PALO) versus granisetron (GRA) in the triplet antiemetic regimen (The TRIPLE study) showed the superiority of PALO over GRA for delayed-phase vomiting in patients receiving cisplatin-based HEC. However, economic efficiency evaluations including quality of life have not been done. The present study was a cost-utility analysis of PALO within the Japanese medical insurance system. Methods The data source was the results of the TRIPLE study. A decision tree was constructed to assess the incremental cost-effectiveness ratio (ICER) using quality-adjusted life years (QALYs) and the medical service fees and the drug price for 2018 from the perspective of the payer. A one-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) were performed to assess the robustness of the model. A threshold analysis was performed to determine the cost-effective price of PALO. Results In the base case, the estimated incremental effect of PALO addition was 0.000645 QALYs, the estimated incremental cost was 10,455 JPY (93.21 USD), and the ICER was 16,204,591 JPY QALY (144,465 USD/QALY). In the PSA, the probability of superior cost-effectiveness was 3.64%. In the threshold analysis, the acceptable price of PALO was estimated to be 7,743 JPY (69.03 USD). Conclusions If willingness-to-pay is taken as 5,000,000 JPY/QALY (44,575 USD/QALY), the antiemetic regimen using PALO for cisplatin-containing HEC was not cost-effective at this time. The cost of drugs, with the arrival of inexpensive generic drugs, will make a major contribution to its cost-effectiveness.

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“…[23][24][25]27,29,31,32,34,35 The efficacy results were analyzed using intention-to-treat approach in 2 RCTs 28,31 and per-protocol analysis or not was reported in the other 10 studies. [22][23][24][25][26][27]29,30,[32][33][34][35] Of the 5 included economic studies, 4 were cost-utility analysis 36,37,39,40 and 1 was a costeffectiveness analysis. 38 The cost-utility analysis by Botteman et al (2020) 36 was conducted using the efficacy data from a phase III noninferior RCT by Zhang et al (2018) 29 to determine the cost-effectiveness of NEPA relative to the granisetron-aprepitant regimen for HEC.…”

Section: Methodsmentioning

confidence: 99%

“…The detailed characteristics of the included SR 21 (Table 2), primary clinical studies (RCTs) [22][23][24][25][26][27][28][29][30][31][32][33][34][35] (Table 3), economic studies [36][37][38][39][40] (Table 4), and guidelines [41][42][43][44][45][46][47] (Table 5) are provided in Appendix 2.…”

Section: Summary Of Study Characteristicsmentioning

confidence: 99%

Palonosetron for Patients Undergoing High or Moderate Emetogenic Chemotherapy

Tran¹,

Loshak²

2021

cjht

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This report identified high to moderate quality evidence from clinical studies and economic evaluations, as well as high-quality guidelines regarding the use of palonosetron in the prevention of chemotherapy-induced nausea and vomiting in adult and pediatric patients receiving different emetogenic chemotherapies. Interpretations of the findings should be taken with caution because of the presence of some identified limitations in both clinical and economic evidence. In adult patients receiving high emetogenic chemotherapy, a fixed antiemetic combination of netupitant and palonosetron (NEPA) plus dexamethasone demonstrated noninferiority relative to a triple regimen of granisetron-aprepitant-dexamethasone. Similarly, palonosetron had similar efficacy compared to granisetron with the co-administration of neurokinin 1 receptor antagonist (e.g., aprepitant or fosaprepitant) and dexamethasone. However, in the absence of aprepitant, a 2-drug combination of palonosetron-dexamethasone appeared to be significantly more effective than granisetron-dexamethasone for the prevention of both acute and delayed emesis. In adult patients receiving moderate emetogenic chemotherapy, palonosetron plus dexamethasone was found to be noninferior compared with ondansetron plus dexamethasone. Similar efficacy was also observed between palonosetron plus dexamethasone and transdermal granisetron plus dexamethasone. In a mixed population of adult patients receiving high or moderate emetogenic chemotherapy, a palonosetron regimen appeared to have greater efficacy than ondansetron for delayed emesis. The efficacy of triple regimen of palonosetron-aprepitant-dexamethasone and granisetron-aprepitant-dexamethasone was comparable at all phases. In pediatric patients receiving high emetogenic chemotherapy, palonosetron plus dexamethasone had similar efficacy compared with ondansetron plus dexamethasone in the acute phase, but was more effective in delayed and overall phases of chemotherapy-induced nausea and vomiting. In a mixed population of pediatric patients receiving high or moderate emetogenic chemotherapy, palonosetron plus dexamethasone was noninferior to ondansetron plus dexamethasone. There were no significant differences between palonosetron and ondansetron or between palonosetron and granisetron treatment regimens in adverse events or quality of life. A cost-utility analysis revealed that NEPA plus dexamethasone was dominant (i.e., cost less, more effective) relative to granisetron-aprepitant-dexamethasone and ondansetron-aprepitant or fosaprepitant-dexamethasone in adult patients receiving high emetogenic chemotherapy. In contrast, double or triple regimens of palonosetron was not cost-effective compared to granisetron regimens, mainly due to large difference in price and small quality-adjusted life-years gained. These economic evaluations may not be applicable to the Canadian context. The identified high-quality guidelines have recommendations on the use of specific antiemetic regimens for adult and pediatric patients receiving high emetogenic chemotherapy or moderate emetogenic chemotherapy and suggest that palonosetron may be offered as an alternative to other 5-hydroxytryptamine-3 receptor antagonists and that 1 5-hydroxytryptamine-3 receptor antagonist is not preferred over another based on the available evidence.

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Cost-utility and budget impact analyses of the use of NEPA for chemotherapy-induced nausea and vomiting prophylaxis in Italy

Cited by 15 publications

References 29 publications

Cost-effectiveness of a fixed combination of netupitant and palonosetron (NEPA) relative to aprepitant plus granisetron (APR + GRAN) for prophylaxis of chemotherapy-induced nausea and vomiting (CINV): a trial-based analysis

Cost-effectiveness of a fixed combination of netupitant and palonosetron (NEPA) relative to aprepitant plus granisetron (APR + GRAN) for prophylaxis of chemotherapy-induced nausea and vomiting (CINV): a trial-based analysis

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

Palonosetron for Patients Undergoing High or Moderate Emetogenic Chemotherapy

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