J. Tang et al., A COMPARISON OF COSTS AND EFFICACY OF ONDANSETRON AND DROPERIDOL AS PROPHYLACTIC ANTIEMETIC THERAPY FOR ELECTIVE OUTPATIENT GYNECOLOGIC PROCEDURES, Anesthesia and analgesia, 83(2), 1996, pp. 304-313
Ondansetron and droperidol are both effective prophylactic antiemetics
for gynecologic outpatient procedures. However, increased drowsiness,
delayed discharge, and postdischarge restlessness may occur with drop
eridol, and ondansetron is costly. In this prospective, randomized, do
uble-blind, placebo-controlled study involving 161 women, we compared
the efficacy, safety, and cost-effectiveness of ondansetron (4 mg intr
avenously [IV]) with droperidol (0.625 mg or 1.25 mg IV) in the preven
tion of postoperative nausea and vomiting (PONV) after outpatient gyne
cologic surgery. The incidence of PONV, times to achieving present rec
overy criteria, and patient-evaluated visual analog scales for sedatio
n, anxiety, pain and nausea were recorded, along with postdischarge em
etic episodes, medications, quality of sleep, and time to resumption o
f food intake, normal activity, and return to work. A decision analysi
s tree was used to divide each data set into nine mutually exclusive s
ubgroups, and costs and probabilities were assigned to each subgroup.
The costs effectiveness ratio was determined by summing these weighted
costs and dividing by the number of patients free from both PONV and
side effects of antiemetic therapy. The incidence of PONV in the hospi
tal and after discharge, the need for rescue antiemetic therapy, and r
ecovery and discharge times were similar for the ondansetron and both
droperidol groups but differed significantly from those for the placeb
o group. The cost-effectiveness ratios for both droperidol 0.625 mg an
d 1.25 mg groups were significantly lower than those for the ondansetr
on and placebo groups. We conclude that droperidol 0.625 mg IV provide
s antiemetic prophylaxis comparable to that of ondansetron 4 mg IV wit
hout increasing side effects or delaying discharge and is more cost-ef
fective.