Economics and health-related quality of life in antiemetic therapy: recommendations for trial design

Emesis (nausea and vomiting) is one of the most important toxicities associ ated with chemotherapy. Although it is not life threatening, it has a major impact on a patient's health-related quality of life (HRQL) and overall re sponse to chemotherapy. New antiemetics are expensive and well-conducted co mparative health economic studies are rare. The aim of the study was to rev iew the literature in the area of chemotherapy-induced emesis in cancer pat ients and to offer recommendations for the inclusion of these outcomes in t he design of clinical trials for new antiemetic therapies. The economic lit erature was reviewed based on methodological standards for economic evaluat ion. Many studies did not comply with standards, specifically with regard t o the choice of alternatives, chosen perspective, setting, type of emesis, measurement of costs and defining outcomes (including health-related qualit y of life). These issues are described for each study and recommendations f or trial design are presented. The role of economic data is to support deci sion making in choosing between competing antiemetic therapies. It is the c ombination of clinical outcomes, costs and health-related quality of life, which will allow treating physicians to comprehensively assess the relative value of antiemetic therapies and to provide the most cost-effective thera py for their patients. (C) 2000 Published by Elsevier Science Ltd. All righ ts reserved.