title: The efficacy and cost-effectiveness of prophylactic 5-hydroxytryptamine3 receptor antagonists: tropisetron, ondansetron and dolasetron.
abstract: There are currently three 5-hydroxytryptamine3 (5-HT3) receptor antagonists available in Australia. In this randomized, double-blind, parallel group study the prophylactic antiemetic effect of a single dose of tropisetron 2 mg, ondansetron 4 mg or dolasetron 12.5 mg was compared after major gynaecological surgery. One hundred and eighteen patients (group T n = 42; group O n = 36; group D n = 40) were evaluated for nausea, vomiting, recovery characteristics and satisfaction for 24 hours postoperatively. A cost-effectiveness analysis was performed. Rescue antiemetic, prochlorperazine 12.5 mg i.m., was given if vomiting occurred more than 10 minutes after arrival in the recovery room. If prochlorperazine was ineffective one hour after administration, droperidol 1 mg i.v. was given. There were no significant differences between groups for the incidence of vomiting during consecutive epochs until 24 hours postoperatively or overall (57%, 75% and 72.5% for groups T, O and D respectively, P = 0.18). The incidence and number of rescue antiementic treatments for nausea or vomiting were similar. The incidence of nausea and the overall and interval nausea scores were similar except for lower "worst nausea" score in group T between 12 and 18 hours (P = 0.02). Recovery times, satisfaction and cost per patient did not differ between groups. We conclude that the risk of postoperative nausea and vomiting remained high in this setting despite 5-HT3 receptor antagonist prophylaxis and that the choice between these agents should be based on the lowest available acquisition cost.
authors.affiliation: Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women and Women and Infants Research Foundation, 374 Bagot Road, Subiaco, W.A. 6008.
authors.forename: M J
authors.initials: MJ
authors.lastname: Paech
authors.forename: M W M
authors.initials: MW
authors.lastname: Rucklidge
authors.forename: S L
authors.initials: SL
authors.lastname: Banks
authors.forename: L C
authors.initials: LC
authors.lastname: Gurrin
authors.forename: C E P
authors.initials: CE
authors.lastname: Orlikowski
authors.forename: T J G
authors.initials: TJ
authors.lastname: Pavy
mesh_terms: D000932:Antiemetics / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D008875:Middle Aged; D017294:Ondansetron / Q000627:therapeutic use*; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy*; D011807:Quinolizines / Q000627:therapeutic use*; D012702:Serotonin Antagonists / Q000191:economics / Q000627:therapeutic use; D000077526:Tropisetron
chemical_list: D000932:Antiemetics; D007211:Indoles; D011807:Quinolizines; D012702:Serotonin Antagonists; D017294:Ondansetron; D000077526:Tropisetron; C060344:dolasetron