A COMPARISON OF COSTS AND EFFICACY OF ONDANSETRON AND DROPERIDOL AS PROPHYLACTIC ANTIEMETIC THERAPY FOR ELECTIVE OUTPATIENT GYNECOLOGIC PROCEDURES

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.