Cost-effectiveness of prophylactic dolasetron or droperidol vs rescue therapy in the prevention of PONV in ambulatory gynecologic surgery

Purpose: To assess the cost-effectiveness of prophylactic therapy (1.25 mg droperidol or 50 mg dolasetron iv) vs no prophylaxis (rescue therapy) for t he prevention of post-operative nausea and vomiting (PONV) from a Canadian hospital perspective, Methods: Design: A predictive decision analytic model using previously publ ished clinical and economic evaluations, and costs of medical care in Canad a. Subjects: Ambulatory gynecology surgery patients, interventions: Three s trategies administered prior to emergence from anesthesia were compared: 1. 25 mg droperidol iv, 50 mg dolasetron iv; and no prophylaxis (res; cue ther apy). Results: The base case mean cost per patient receiving dolasetron prophylax is was $28.08 CAN compared with $26.88 CAN per patient receiving droperidol prophylaxis, resulting in a marginal cost of $1.20 CAN. This difference tr anslated in an additional cost of $12.00 CAN for the dolasetron strategy pr adverse event avoided over the droperidol strategy. The base case mean cos t per patient not receiving prophylaxis was $26.92 resulting in marginal co sts of $1.16 CAN and $0.04 CAN when compared to dolasetron and droperidol, respectively. Compared with the no prophylaxis strategy, dolasetron prophyl axis resulted in an incremental cost-effectiveness ratio of $5.82 CAN per a dditional PONV-free patient. The mean costs incurred per PONV-free patient were calculated to be $48.41 for the dolasetron strategy $46.34 for the dro peridol strategy and $70.83 for the no prophylaxis strategy. Conclusions: Dolasetron and droperidol given intraoperatively were more cos t-effective than no prophylaxis for PONV in patients undergoing ambulatory gynecologic surgery. The difference between the two agents was small and fa voured droperidol, The model was robust to plausible changes through sensit ivity analyses.