title: A cost-utility analysis of risk model-guided versus physician's choice antiemetic prophylaxis in patients receiving chemotherapy for early-stage breast cancer: a net benefit regression approach.
abstract: We assessed the cost-effectiveness of a risk model-guided (RMG) antiemetic prophylaxis strategy compared with the physician's choice (PC) strategy in patients receiving chemotherapy for early-stage breast cancer.
  
  
  
  We conducted a cost-utility analysis based on a published randomized controlled trial of 324 patients with early-stage breast cancer undergoing chemotherapy at two Canadian cancer centers. Patients were randomized to receive their antiemetic treatments according to either predefined risk scores or the treating physician's preference. Effectiveness was measured as quality-adjusted life years (QALYs) gained. Cost and utility data were obtained from the Canadian published literature. We used generalized estimating equations to estimate the incremental cost-effectiveness ratios (ICERs) and 95% confidence intervals (CIs) over a range of willingness-to-pay values. The lower and upper bounds of the 95% CIs were used to characterize the statistical uncertainty for the cost-effectiveness estimates and construct cost-effectiveness acceptability curves.
  
  
  
  From the health care system's perspective, the RMG strategy was associated with greater QALYs gained (0.0016, 95% CI 0.0009, 0.0022) and higher cost ($49.19, 95% CI $24.87, $73.08) than the PC strategy, resulting in an ICER of $30,864.28 (95% CI $14,718.98, $62,789.04). At the commonly used threshold of $50,000/QALY, the probability that RMG prophylaxis is cost-effective was >94%; this probability increased with greater willingness-to-pay values.
  
  
  
  The risk-guided antiemetic prophylaxis is an economically attractive option for patients receiving chemotherapy for early-stage breast cancer. This information supports the implementation of risk prediction models to guide chemotherapy-induced nausea and vomiting prophylaxis in clinical practices.
authors.affiliation: Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada. kthavorn@ohri.ca.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada. kthavorn@ohri.ca.|Institute for Clinical Evaluative Sciences (ICES uOttawa), Ottawa, ON, Canada. kthavorn@ohri.ca.
authors.forename: Kednapa
authors.identifier: 0000-0003-4738-8447
authors.initials: K
authors.lastname: Thavorn
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
authors.affiliation: Department of Public Health Sciences, University of California, Davis, CA, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hoch
authors.affiliation: Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Vandermeer
authors.affiliation: Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Mazzarello
authors.affiliation: Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Statistical Consultant, Toronto, ON, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Dranitsaris
authors.affiliation: Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.|Department of Medicine, University of Ottawa, Ottawa, Canada.|Department of Surgery, University of Ottawa, Ottawa, Canada.
authors.forename: Dean
authors.initials: D
authors.lastname: Fergusson
authors.affiliation: Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, PO Box 201B, Ottawa, ON, K1H 8L6, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada.|Division of Medical Oncology and Department of Medicine, University of Ottawa, Ottawa, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Clemons
mesh_terms: D000932:Antiemetics / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics*; D002755:Choice Behavior / Q000187:drug effects*; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010820:Physicians; D012306:Risk
chemical_list: D000932:Antiemetics
keywords: Chemotherapy-induced nausea and vomiting; Early stage breast cancer; Economic evaluation; Net-benefit regression approach; Risk model-guided antiemetic prophylaxis strategy