Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo

Background: In an era of growing economic constraints on healthcare deliver y, anesthesiologists are increasingly expected to understand cost analysis and evaluate clinical practices. Postoperative nausea and vomiting (PONV) a re distressing for patients and may increase costs in an ambulatory surgica l unit. The authors compared the cost-effectiveness of four prophylactic in travenous regimens for PONV: 4 mg ondansetron, 0.625 mg droperidol, 1.25 mg droperidol, and placebo. Methods: Adult surgical outpatients at high risk for PONV were studied. Stu dy drugs were administered intravenously within 20 min of induction of nitr ous oxide-isoflurane or enflurane anesthesia. A decision-tree analysis was used to group patients into 12 mutually exclusive subgroups based on treatm ent and outcome. Costs were calculated for the prevention and treatment of PONV, Cost-effectiveness analysis was per formed for each group. Results: Two thousand sixty-one patients were enrolled. Efficacy data for s tudy drugs have been previously reported, and the database from that study was used for pharmacoeconomic analysis. The mean-median total cost per pati ent who received prophylactic treatment with 4 mg ondansetron, 0.625 mg dro peridol, 1.25 mg droperidol, and placebo were $112 or $16.44, $109 or $0.63 , $104 or $0.51, and $164 or $51.20, respectively (P = 0.001, active treatm ent groups vs. placebo). The use of a prophylactic antiemetic agent signifi cantly increased patient satisfaction (P < 0.05), Personnel costs in managi ng PONV and unexpected hospital admission constitute major cost components In our analysis. Exclusion of nursing labor costs from the calculation did not alter the overall conclusions regarding the relative costs of antiemeti c therapy. Conclusion The use of prophylactic antiemetic therapy in high-risk ambulato ry surgical patients was more effective in preventing PONV and achieved gre ater patient satisfaction at a lower cost compared with placebo. The use of 1.25 mg droperidol Intravenously was associated with greater effectiveness , lower costs, and similar patient satisfaction compared with 0.625 mg drop eridol intravenously and 4 mg ondansetron intravenously.