NEPA, a new fixed combination of netupitant and palonosetron, is a cost-effective intervention for the prevention of chemotherapy-induced nausea and vomiting in the UK

Abstract

BackgroundThe objective was to evaluate the cost-effectiveness of NEPA, an oral fixed combination netupitant (NETU, 300 mg) and palonosetron (PA, 0.5 mg) compared with aprepitant and palonosetron (APPA) or palonosetron (PA) alone, to prevent chemotherapy-induced nausea and vomiting (CINV) in patients undergoing treatment with highly or moderately emetogenic chemotherapy (HEC or MEC) in the UK.ScopeA systematic literature review and meta-analysis were undertaken to compare NEPA with currently recommended anti-emetics. Relative effectiveness was estimated over the acute (day 1) and overall treatment (days 1–5) phases, taking complete response (CR, no emesis and no rescue medication) and complete protection (CP, CR and no more than mild nausea [VAS scale <25 mm]) as primary efficacy outcomes. A three-health-state Markov cohort model, including CP, CR and incomplete response (no CR) for HEC and MEC, was constructed. A five-day time horizon and UK NHS perspective were adopted. Transition probabilities were obtained by combining the response rates of CR and CP from NEPA trials and odds ratios from the meta-analysis. Utilities of 0.90, 0.70 and 0.24 were defined for CP, CR and incomplete response, respectively. Costs included medications and management of CINV-related events and were obtained from the British National Formulary and NHS Reference Costs. The expected budgetary impact of NEPA was also evaluated.FindingsIn HEC patients, the NEPA strategy was more effective than APPA (quality-adjusted life days [QALDs] of 4.263 versus 4.053; incremental emesis-free and CINV-free days of +0.354 and +0.237, respectively) and was less costly (£80 versus £124), resulting in NEPA being the dominant strategy. In MEC patients, NEPA was cost effective, cumulating in an estimated 0.182 extra QALDs at an incremental cost of £6.65 compared with PA.ConclusionDespite study limitations (study setting, time horizon, utility measure), the results suggest NEPA is cost effective for preventing CINV associated with HEC and MEC in the UK.

Cost-Effectiveness of Aprepitant in Preventing Chemotherapy-Induced Nausea and Vomiting: A Systematic Review of Published Articles

“…Ten of the 13 economic studies included data of clinical outcomes from randomized controlled trials. The clinical data of Chanthawong et al ( 22 ) and Cawston et al ( 20 ) came from systematic review and metaanalysis. Nakamura et al ( 27 ) acquired data from a retrospective analysis of direct medical costs of National Hospital Organization Nagoya Medical Center between January 2009 and December 2013.…”

“…Of the 13 studies included, eight of used the decision analytical model ( 18 , 21 – 25 , 28 , 30 ), four used the Markov model ( 19 , 20 , 26 , 29 ), and one study did not use model analysis ( 27 ).…”

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

“…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]. The results are also consistent with the finding-noted within the National Comprehensive Cancer Network (NCCN) guidelines for antiemesis [8]-that netupitant is effective at decreasing delayed nausea.…”

“…Utilities of 0.90, 0.70, and 0.24 were assigned for the outcomes of CP, CR, and IR, respectively, consistent with previously published economic models for CINV [20,21]. Quality-adjusted life-days (QALDs) were calculated by summing the patient's quality-adjusted time over the 5-day trial; given the average age and disease burden, the maximum possible QALDs (i.e., having no CINV) for the period was 4.5 (i.e., 0.90 × 5 days).…”

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

“…Cawston et al reported the cost-effectiveness of a combination drug (NEPA: netupitant plus palonosetron), comparing the combination with APR and PALO using a Markov model in the UK medical care system. They reported that NEPA was cost-effective for preventing CINV associated with highly or moderately emetogenic chemotherapy in the UK [27]. 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.…”