Cost-effectiveness of prophylactic dolasetron or droperidol vs rescue therapy in the prevention of PONV in ambulatory gynecologic surgery.
OBJECTIVE
To assess the cost-effectiveness of prophylactic therapy (1.25 mg droperidol or 50 mg dolasetron i.v.) vs no prophylaxis (rescue therapy) for the prevention of post-operative nausea and vomiting (PONV) from a Canadian hospital perspective.


METHODS



METHODS
A predictive decision analytic model using previously published clinical and economic evaluations, and costs of medical care in Canada.


METHODS
Ambulatory gynecology surgery patients.


METHODS
Three strategies administered prior to emergence from anesthesia were compared: 1.25 mg droperidol i.v., 50 mg dolasetron i.v.; and no prophylaxis (rescue therapy).


RESULTS
The base case mean cost per patient receiving dolasetron prophylaxis 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 translated in an additional cost of $12.00 CAN for the dolasetron strategy per adverse event avoided over the droperidol strategy. The base case mean cost per patient not receiving prophylaxis was $26.92 resulting in marginal costs of $1.16 CAN and $0.04 CAN when compared to dolasetron and droperidol, respectively. Compared with the no prophylaxis strategy, dolasetron prophylaxis resulted in an incremental cost-effectiveness ratio of $5.82 CAN per additional 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 droperidol strategy and $70.83 for the no prophylaxis strategy.


CONCLUSIONS
Dolasetron and droperidol given intraoperatively were more cost-effective than no prophylaxis for PONV in patients undergoing ambulatory gynecologic surgery. The difference between the two agents was small and favoured droperidol. The model was robust to plausible changes through sensitivity analyses.
Frighetto
L
L
Clinical Drug Research Program, CSU Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Centre, BC, Canada.
Loewen
P S
PS
Dolman
J
J
Marra
C A
CA
D000556:Ambulatory Surgical Procedures / Q000009:adverse effects; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002170:Canada; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D004329:Droperidol / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D005260:Female; D005544:Forecasting; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D007275:Injections, Intravenous; D007430:Intraoperative Care / Q000191:economics; D008787:Metoclopramide / Q000191:economics / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D011336:Probability; D011346:Prochlorperazine / Q000191:economics / Q000627:therapeutic use; D011807:Quinolizines / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000932:Antiemetics; D007211:Indoles; D011807:Quinolizines; C060344:dolasetron; D008787:Metoclopramide; D004329:Droperidol; D011346:Prochlorperazine