PHARMACOECONOMIC ANALYSIS OF ONDANSETRON VERSUS METOCLOPRAMIDE FOR CISPLATIN-INDUCED NAUSEA AND VOMITING

A pharmacoeconomic analysis of ondansetron versus metoclopramide use i n patients receiving high-dose cisplatin therapy is reported. A meta-a nalysis of the literature was performed to synthesize the results of c linical trials of ondansetron and metoclopramide for the prevention of nausea and vomiting in patients receiving high-dose cisplatin therapy . A cost-benefit analysis was performed by constructing a decision tre e of the possible outcomes of treatment with ondansetron or metoclopra mide. Clinical outcomes were measured by counting the emesis episodes occurring within 24 hours after the antiemetic was given and the extra pyramidal reactions occurring after metoclopramide was given. The impr ovement in quality of life was transformed to an increase in quality-a djusted life years (QALYs) in order to conduct a cost-utility analysis . Only direct costs of drug, materials, and labor were included in the cost calculations. The meta-analysis, combined with empirical observa tions, yielded expected emesis rates of 2.03 and 2.69 per patient for ondansetron and metoclopramide, respectively. The rate of extrapyramid al symptoms for metoclopramide recipients was 6.8%. The cost-benefit a nalysis yielded estimated total costs of $139 ($211) and $116 ($154) p er 40-kg (70-kg) patient receiving ondansetron and metoclopramide, res pectively. The cost-utility analysis yielded an incremental cost of on dansetron of $168,391 ($407,667) per QALY in 40-kg (70-kg) patients. S ensitivity analysis showed robustness of the expected outcomes except in a best-case scenario. A cost-utility analysis suggested that, compa red with metoclopramide, ondansetron provides a small antiemetic benef it at a large additional cost.