EVALUATION OF ONDANSETRON PRESCRIBING IN US ACADEMIC MEDICAL-CENTERS

Background: The study objectives were to characterize the use of the a ntiemetic ondansetron, a serotonin subtype 3 receptor antagonist, in U S academic medical centers, and to assess ondansetron prescribing with consensus-derived prescribing guidelines used as evaluation criteria. Methods: A multicenter, prospective, observational study was conducte d in the inpatient and outpatient care areas of 23 US academic medical centers. A total of 670 patients received ondansetron (508 inpatients and 162 outpatients). The use of ondansetron was compared with consen sus-derived prescribing guidelines on the basis of indication for use and dose administered. Results: Only 253 (37.8%) of the 670 patients s atisfied the prescribing guidelines for both indication for use and do se administered. The remainder of the patients did not satisfy the gui delines, in whole or in part. If all ondansetron use had met the presc ribing guidelines in the patients studied, a reduction in ondansetron use of 31% (16 185/52 260 mg) would have been realized. At an estimate d cost of $5 per milligram, this reduction represents a potential cost savings of nearly $81 000, or $121 per patient studied. Conclusion: S ince its introduction in 1991, ondansetron has become a commonly used antiemetic in US academic medical centers. Although ondansetron is saf e and effective in improving patients' tolerance of emetogenic therapi es, including cancer chemotherapy, its high cost has added a significa nt burden to the pharmaceutical budgets of many institutions. The stud y data suggest that compliance with ondansetron prescribing guidelines , with elimination of indiscriminant use, could result in significant cost savings.