Health outcomes and cost-effectiveness of aprepitant in outpatients receiving antiemetic prophylaxis for highly emetogenic chemotherapy in Germany.
BACKGROUND
Chemotherapy-induced nausea and vomiting (CINV) remains a major adverse effect of cancer therapy. We aimed to determine outcomes associated with use of aprepitant in outpatients undergoing highly emetogenic chemotherapy in Germany from a patient's and payer's perspective.


METHODS
A decision-analytic model compared an aprepitant regimen (aprepitant/ondansetron/dexamethasone) to a control regimen (ondansetron/dexamethasone) over a five days period. Clinical results and resource utilisation observed in aprepitant phase III clinical trials were assigned German unit cost data.


RESULTS
Complete response over one chemotherapy cycle was observed in 68% of patients in the aprepitant group (N=514) compared to 48% of patients in the control group (N=518). Patients were estimated to have gained an equivalent of 15 additional hours of perfect health per cycle (0.63 quality-adjusted life days) with aprepitant-based regimen compared to control regimen. Cost per quality-adjusted life year gained with aprepitant was estimated at euro28,891.


CONCLUSIONS
Aprepitant substantially improved CINV-related health outcomes in patients undergoing highly emetogenic chemotherapy. Incremental benefits materialised in a cost-effective fashion.
Lordick
Florian
F
Third Medical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany. f.lordick@lrz.tu-muenchen.de
Ehlken
Birgit
B
Ihbe-Heffinger
Angela
A
Berger
Karin
K
Krobot
Karl J
KJ
Pellissier
James
J
Davies
Glenn
G
Deuson
Robert
R
D000932:Antiemetics / Q000191:economics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000077608:Aprepitant; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D009025:Morpholines / Q000191:economics / Q000627:therapeutic use*; D015337:Multicenter Studies as Topic; D009325:Nausea / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics; D017294:Ondansetron / Q000191:economics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control
D000932:Antiemetics; D009025:Morpholines; D000077608:Aprepitant; D017294:Ondansetron; D003907:Dexamethasone; D002945:Cisplatin