COST-REDUCING TREATMENT ALGORITHMS FOR ANTINEOPLASTIC DRUG-INDUCED NAUSEA AND VOMITING

A treatment algorithm and preprinted order form developed to reduce th e cost of treating antineoplastic drug-induced nausea and vomiting are described. A team including pharmacists, oncologists, and oncology nu rses developed a treatment algorithm to reduce the cost of antiemetic therapy for patients receiving antineoplastic therapy at a 719-bed aca demic medical center. The algorithm incorporated the following concept s: matching antiemetic therapy with the emetogenic potential of the an tineoplastic regimen, reducing ondansetron dosages, increasing the rat io of oral to intravenous therapy, and treating delayed-onset nausea a nd vomiting without using serotonin-receptor antagonists. To help phys icians learn and use the treatment algorithm, it was incorporated into an order form for both antineoplastic and antiemetic drugs. Separate order forms were created for pediatric and adult patients. A compariso n of outcome data before and after implementation of the practice guid elines showed that the patient outcomes were at least as good after im plementation as before. More than a year after the guidelines were imp lemented, more than 85% of antiemetic regimens prescribed for antineop lastic drug-induced nausea and vomiting were in compliance with the gu idelines. A cost avoidance of nearly $205,000 was realized in the firs t year. Collaboration with oncologists at the start of the care plan w as a key element in its success. An antiemetic treatment algorithm, in tegrated with a preprinted physician order form, was well accepted and has reduced expenses for antiemetic therapy.