Ondansetron: A Cost-Effective Advance in Anti-Emetic Therapy

Abstract

A cost-effectiveness analysis is one form of full economic evaluation where drug acquisition costs and the costs that are incurred as a result of using a particular treatment are assessed together with clinical efficacy. This paper reviews two such studies. One of the studies was a prospective randomised cost-effectiveness study which compared ondansetron (8 mg i.v. 0, 4 and 8 h following chemotherapy) with metoclopramide (3 mg/kg i.v. followed by an infusion of 0.5 mg/kg/h for 8 h) over the first 24 h following chemotherapy in hospitalised patients receiving highly emetogenic chemotherapy. This study showed that the cost per successfully treated patient (defined in this study as having < 1 emetic episode and no adverse events) for these 2 treatments were approximately equal: ondansetron E95 and metoclopramide E92. The second study was an economic evaluation based on data collected over a 5-day period following cyclophosphamide-based chemotherapy given on an outpatient basis for the treatment of breast cancer. Patients received an intravenous dose of 16 mg dexamethasone with either 8 mg ondansetron or 60 mg metoclopramide intravenously before chemotherapy followed by oral dosing with 8 mg ondansetron or 20 mg metoclopramide 3 times daily for 5 days. The costs per successfully treated patient (defined in this study as no vomiting or retching episodes and no anti-emetic-related adverse events during the 5-day period) were comparable: ondansetron E184 and metoclopramide E160. A recent study has established that ondansetron (8 mg) given orally twice daily is as effective as the same dose given 3 times a day. A sensitivity analysis using the cost of an ondansetron twice daily regimen showed that ondansetron is more cost-effective than metoclopramide (E133 vs. E 160). These cost effectiveness studies have shown that ondansetron is at least as cost-effective as metoclopramide and simplified ondansetron dosing schedules render ondansetron more cost-effective. These full economic evaluations illustrate that drug acquisition costs can be a misleading guide to the economic impact of antiemetics.

Cost-Effectiveness Analysis of Granisetron-Based versus Standard Antiemetic Regimens in Low-Emetogenic Chemotherapy: A Hospital-based Perspective from Malaysia

“…This was mainly attributable to the high differential cost between the original granisetron (Kytril ® ) and generic metoclopramide or dexamethasone marketed in Malaysia. Unlike most of the previous pharmacoeconomic studies of antiemetics in chemotherapy which had favored the new treatment (Cox and Hirsch, 1993;Cunningham et al, 1993;Lordick et al, 2007;Lopes et al, 2012;Humphreys et al, 2013), our results had indicated a high ICER (MYR 430.66 per successfully treated patient) of granisetron-based regimen relative to standard regimen. To date, Malaysia does not have a published threshold to determine costeffectiveness of antiemetics.…”

“…In our study, whilst the ratio of drug acquisition costs for granisetron-based and standard regimens was 40.70, the corresponding ratio of total cost for two sets of treatment was reduced to 8.68 (relative change of 468.9%). This again clearly demonstrated that judging the differential cost between two treatment alternatives based on drug acquisition costs alone could be misleading (Cox and Hirsch, 1993).…”

“…Antiemetic treatment is always the target of these studies due to its high acquisition cost and the lack of curative effects (Uyl-de Groot et al, 2000). To date, almost all the pharmacoeconomic studies of antiemetic treatment have been targeting the most costly items including aprepitant (Lordick et al, 2007;Moore et al, 2007;Annemans et al, 2008;Lopes et al, 2012) and serotonin type-3 (5HT-3) antagonists (Cox and Hirsch, 1993;Cunningham et al, 1993;Ballatori et al, 1994;Colayco and Hay, 2010). Overall, most of the findings showed that adding these new agents to the traditional antiemetic regimens provides incremental benefits in terms of cost-effectiveness.…”

The Management of Children with Gastroenteritis and Dehydration in the Emergency Department

“…However, as noted in the above studies, the use of ondansetron can be associated with a decrease in need for hospitalization and therefore may be cost-effective (35,(67)(68)(69). Cost-effectiveness studies comparing ondansetron with metoclopramide in oncology patients have shown that ondansetron administered three times a day is at least as costeffective as metoclopramide, whereas twice-a-day regimens of ondansetron are more cost-effective (78). The doses and route of administration of ondansetron in the above-mentioned investigations can be seen in Table 7.…”

A randomized clinical trial comparing oral ondansetron with placebo in children with vomiting from acute gastroenteritis

“…Cost-effectiveness studies comparing ondansetron with metoclopramide in oncology patients have shown that ondansetron administered three times a day is at least as cost-effective as metoclopramide, while twice-a-day regimens are more cost-effective. 27 Hospital acquisition costs for ondansetron are approximately US$4.01 per milligram for intravenous ondansetron and less for oral preparations, but patient charges vary greatly nationwide. 28 Given the cost of intravenous fluid therapy, especially if it includes admission, 5 single-dose ondansetron at a cost of less than US$20 is an attractive alternative.…”