title: Resource Utilization for Chemotherapy-Induced Nausea and Vomiting Events in Patients with Solid Tumors Treated with Antiemetic Regimens.
abstract: BACKGROUND
  Chemotherapy-induced nausea and vomiting (CINV) can lead to increased emergency department visits and hospitalizations, which may contribute to increased cost of care. Antiemetic agents, such as neurokinin-1 (NK1) receptor antagonists and 5-hydroxytryptamine (5-HT3) receptor antagonists, are prescribed for patients receiving highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). The current guidelines recommend a 3-drug combination of an NK1 receptor antagonist, a 5-HT3 receptor antagonist, and dexamethasone with HEC regimens and certain MEC regimens.
  
  
  OBJECTIVE
  To compare the incidence of CINV and CINV-related resource utilization among patients who receive guideline-adherent HEC and MEC regimens and patients who receive non-guideline-adherent regimens.
  
  
  METHODS
  In this retrospective, claims-based study, Inovalon's Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry) Research Edition database was used to identify 8089 patients with solid tumors receiving therapy with anthracycline plus cyclophosphamide (AC), cisplatin, or carboplatin from June 2013 to December 2013. The patients were stratified according to the use of an NK1 receptor antagonist regimen. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify CINV events associated with hospital, emergency department, and outpatient office visits among patients in the NK1 receptor antagonist group and the non-NK1 receptor antagonist group.
  
  
  RESULTS
  A total of 1059 patients were included in the analysis, of whom 51% (N = 536) used an NK1 receptor antagonist-based regimen and 49% (N = 523) used non-NK1 receptor antagonist therapy. A higher percentage of patients receiving AC (73%) than cisplatin (56%) or carboplatin (23%) received an NK1 receptor antagonist. The incidence rates of total CINV events and CINV-related emergency department visits were lower in the group receiving an NK1 receptor antagonist (44% and 9%, respectively) than in the group receiving a non-NK1 receptor antagonist (50% and 15%, respectively).
  
  
  CONCLUSIONS
  The patients receiving an NK1 receptor antagonists had a lower rate of resource utilization, suggesting that the use of NK1 receptor antagonist-containing regimens according to current national guidelines may reduce healthcare resource utilization, such as CINV-related office, hospital, and emergency department visits for patients receiving highly and moderately emetogenic chemotherapy.
authors.affiliation: Medical Director, West Clinic, and Chief, Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis.
authors.forename: Lee
authors.initials: L
authors.lastname: Schwartzberg
authors.affiliation: Director, Medical Affairs Research-HEOR, TESARO, Waltham, MA.
authors.forename: Brooke
authors.initials: B
authors.lastname: Harrow
authors.affiliation: Director, HEOR Clinical Specialty Solutions, Cardinal Health, Dallas, TX.
authors.forename: Lincy S
authors.initials: LS
authors.lastname: Lal
authors.affiliation: Director, Client Services Specialty Solutions, Cardinal Health, Dallas, TX.
authors.forename: Janna
authors.initials: J
authors.lastname: Radtchenko
authors.affiliation: Co-Director, Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Lyman
keywords: 5-HT3 receptor antagonists; NK1 receptor antagonist; antiemetic agents; chemotherapy-induced nausea and vomiting; emetogenic chemotherapy; resource utilization