Economic Value of Fosaprepitant-Containing Regimen in the Prevention of Chemotherapy-Induced Nausea and Vomiting in China: Cost-Effectiveness and Budget Impact Analysis

Abstract

ObjectiveThe purpose of this study was to evaluate the cost-effectiveness and budget impact of fosaprepitant (FosAPR)-containing regimen for the prevention of chemotherapy-induced nausea and vomiting (CINV) among patients receiving high emetogenic chemotherapy (HEC) from the Chinese payer's perspective.MethodsA decision tree model was established to measure the 5-day costs and health outcomes between the APR-containing regimen (aprepitant, granisetron, and dexamethasone) and FosAPR-containing regimen (fosaprepitant, granisetron, and dexamethasone). Clinical data were derived from a randomized, double-blind controlled trial on Chinese inpatients who received HEC. Quality-adjusted life-years (QALYs) were used to estimate the utility outcomes and the incremental cost-effectiveness ratio (ICER) was calculated to assess the economics of FosAPR. A static budget impact model was developed to assess the impact of FosAPR as a new addition to the National Reimbursement Drug List (NRDL) on the medical insurance fund within 3 years in Nanjing, China.ResultsCompared with APR, FosAPR had a mean health-care savings of ¥121.56 but got a reduction of 0.0001815 QALY, resulting in an ICER of ¥669926.19 per QALY. Deterministic sensitivity analysis revealed that the cost of APR was the most influential factor to the ICER. The cost of FosAPR and the complete control rate of the delayed period also had a high impact on the results. According to the probabilistic analysis, the acceptability of FosAPR was more than 80% when the Chinese willingness-to-pay (WTP) was ¥215,999. FosAPR would lead to a 3-year medical insurance payment increase of ¥1.84 million compared with ¥1.49 million before FosAPR entered NRDL in Nanjing. The total budget increased with a cumulative cost of ¥694,829 and covered an additional 341 patients who benefited from FosAPR in Nanjing. Deterministic sensitivity analysis showed that the model of budget impact analysis was stable.ConclusionFosAPR had a similar treatment effect to APR but was cost-effective in China at the current WTP threshold. The total budget of medical insurance payments of Nanjing slightly increased year by year after the inclusion of FosAPR. Its inclusion in the NRDL would be acceptable and also expand the coverage of patients who benefited from FosAPR.

Comparison of oral aprepitant and intravenous fosaprepitant for prevention of chemotherapy-induced nausea and vomiting in pediatric oncology patients: a randomized phase III trial

“…For patients discharged after overnight chemotherapy administration, compliance with home dosing of oral aprepitant may be challenging, particularly in a nauseated child. In terms of cost-effectiveness, recent reports suggest an advantage for the use of single-dose fosaprepitant compared to the 3-day oral aprepitant regimen ( 21 , 22 ). Although hypersensitivity reactions and phlebitis have been reported in adults receiving fosaprepitant ( 23 ), these symptoms were not identified on this study in which fosaprepitant was infused through a central access device in all patients.…”

Fosaprepitant: current options to prevent chemotherapy-induced nausea and vomiting: A review

“…В 2022 г. в Китае X. Xu и соавт. опубликовали результаты сравнительного анализа экономической эффективности и влияния на бюджет тройной схемы с антагонистом рецепторов нейрокинина-1 фосапрепитантом, гранисетроном и дексаметазоном для профилактики тошноты и рвоты у пациентов, получающих высокоэметогенную ХТ [51]. С этой целью создали модель принятия решений для измерения затрат при использовании двух схем, содержащих апрепитант, гранисетрон, дексаметазон и фосапрепитант.…”

“…Результаты клинических исследований и фармакоэкономическая оценка подтвердили, что фосапрепитант яв- ляется лучшим выбором для профилактики тошноты и рвоты, индуцированных ХТ, чем апрепитант. Добавление фосапрепитанта может до некоторой степени увеличить нагрузку на фонд государственного медицинского страхования, но это позволит увеличить охват пациентов, которые получили бы пользу благодаря его использованию [51]. Безусловно, тошнота и рвота, ассоциированные с ХТ, оказывают негативное влияние на качество жизни больных, однако исследований, посвященных этому вопросу, недостаточно.…”