Evaluation of outcomes in converting from intravenous ondansetron to oral granisetron: an observational study

OBJECTIVE: TO describe a systematic evaluation of the outcomes associated w ith revising institutional guidelines for the prevention of acute chemother apy-induced nausea and vomiting (CINV) to promote cost-effective use of the serotonin (5-HT3) antagonists. METHODS: The 5-HT3 antagonist of choice in the antiemetic guidelines was re vised from intravenous ondansetron to oral granisetron in August 1995. Pati ent assessments were conducted immediately prior to (Period 1) and after (P eriod 2) guideline revision using validated questionnaires. The effectivene ss of the two 5-HT3 antagonists were compared and reported to the prescribi ng oncologists. Outcomes were assessed one year after guideline revision (P eriod 3) using identical methods. 1 RESULTS: No difference was found in the rate of total control (no emesis, n o nausea) between patients receiving oral granisetron (60%) and intravenous ondansetron (56%) (p = 0.408, Period 1 vs. 2). Nausea severity, the number of emesis episodes, and use of rescue antiemetics were also equivalent. Pr escriber compliance with using the 5-HT3 antagonist of choice and dose incr eased from 48% to 61% following adoption of oral granisetron. By Period 3, compliance increased to 78%, and satisfactory control of acute CINV was aga in documented. The costs for prevention of acute CINV decreased from $107 i n Period 1 (intravenous ondansetron only) to $65 in Period 3 (oral graniset ron). CONCLUSIONS: Outcomes associated with use of oral granisetron and intraveno us ondansetron were equivalent in this patient population. Guideline revisi on and outcome documentation by the oncology pharmacists resulted in increa sed compliance with institution guidelines and a 40% cost savings.