A comparison of the costs and efficacy of ondansetron versus dolasetron for antiemetic prophylaxis

The optimal dose and timing of 5-HT3 antagonist administration for prophyla xis against postoperative nausea and vomiting (PONV) remains controversial. Although 5-HT3 antagonists seem to be most effective when administered nea r the end of surgery, there are no data on the comparative efficacy or cost s associated with the 5-HT3 antagonists dolasetron and ondansetron when adm inistered at the end of the operation. In this double-blinded study, 200 ou tpatients undergoing otolaryngologic procedures with a standardized general anesthetic received 4 (O4) or 8 mg (O8) of ondansetron or 12.5 (D12.5) or 25 mg (D25) of dolasetron IV within 30 min before the end of surgery. A bli nded observer recorded the emetic episodes, maximum nausea score, recovery room resource and drug use, nursing time spent managing PONV, times to achi eve discharge criteria from the Phase 1 and 2 recovery units, postdischarge emesis, and patient satisfaction. Total costs were calculated by using the perspective of a free-standing surgicenter. There were no differences in p atient demographics, incidence of PONV, need for rescue medications, time s pent in the recovery areas, unanticipated hospital admissions, or patient s atisfaction among the four treatment groups. The mean total costs (95% conf idence intervals) to prevent PONV in one patient were lowest in the D12.5 g roup: $23.89 (17.18-28.79) vs S37.81 (30.29-45.32), $33.91 (28.92-39.35), a nd $75.18 (61.13-89.24) for D25, O4, and O8, respectively. Excluding nursin g labor costs did not alter this finding: $18.51 (14.18-22.85), $34.77 (28. 03-41.49), $31.77 (28.92-39.35), and $71.76 (58.17-85.35) for D12.5, D25, O 4., and O8, respectively. We conclude that 12.5 mg of dolasetron TV is more cost effective than 4 mg of ondansetron IV for preventing PONV after otola ryngologic surgery and is associated with similar patient satisfaction.