title: Implementation of institutional antiemetic guidelines for low emetic risk chemotherapy with docetaxel: a clinical and cost evaluation.
abstract: OBJECTIVE
  The purposes of this study were to evaluate the effect of implementation of institutional guidelines for low emetic risk chemotherapy with docetaxel and estimate the cost saving for all low emetic risk chemotherapies.
  
  
  METHODS
  We examined the clinical effect of preparing and implementing institutional antiemetic guidelines for the breast cancer patients receiving adjuvant docetaxel therapy. Although the antiemetic medication for such patients used to be ondansetron 4 mg plus dexamethasone 8 mg (OND + DEX), it was changed to dexamethasone (DEX) 12 mg alone after implementation of the institutional guidelines. The effectiveness and adverse effects of DEX alone (56 patients, 205 courses) were compared with those of OND + DEX (41 patients, 151 courses). The cost saving was calculated from the antiemetic costs in both groups. The annual cost saving was estimated from the number of all low emetic risk chemotherapies in a year.
  
  
  RESULTS
  The incidences of nausea (19.5% versus 16.1%), vomiting (2.4% versus 0%), constipation (34.1% versus 30.4%), and insomnia (17.1% versus 17.9%) were not significantly different between the OND + DEX group and DEX alone group. In all low emetic risk chemotherapies, US $78,883 of potential cost saving was estimated in the first year after changing the antiemetic treatment.
  
  
  CONCLUSIONS
  The present results suggest that DEX alone is equally effective for preventing nausea and vomiting and less expensive compared with a 5-HT(3) receptor antagonist plus DEX in low emetic risk chemotherapy with docetaxel.
authors.affiliation: Department of Pharmacy, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
authors.forename: Toshinobu
authors.initials: T
authors.lastname: Hayashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ikesue
authors.forename: Taito
authors.initials: T
authors.lastname: Esaki
authors.forename: Mami
authors.initials: M
authors.lastname: Fukazawa
authors.forename: Motoaki
authors.initials: M
authors.lastname: Abe
authors.forename: Shinji
authors.initials: S
authors.lastname: Ohno
authors.forename: Tatsuru
authors.initials: T
authors.lastname: Tomizawa
authors.forename: Ryozo
authors.initials: R
authors.lastname: Oishi
mesh_terms: D000932:Antiemetics / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D016009:Chi-Square Distribution; D003248:Constipation / Q000139:chemically induced; D017046:Cost Savings; D003907:Dexamethasone / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000077143:Docetaxel; D005260:Female; D006801:Humans; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced* / Q000517:prevention & control*; D017294:Ondansetron / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced; D043823:Taxoids / Q000009:adverse effects* / Q000627:therapeutic use; D014839:Vomiting / Q000139:chemically induced* / Q000517:prevention & control*
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel; D017294:Ondansetron; D003907:Dexamethasone