title: NEPA, a new fixed combination of netupitant and palonosetron, is a cost-effective intervention for the prevention of chemotherapy-induced nausea and vomiting in the UK.
abstract: BACKGROUND
  The objective was to evaluate the cost-effectiveness of NEPA, an oral fixed combination netupitant (NETU, 300 mg) and palonosetron (PA, 0.5 mg) compared with aprepitant and palonosetron (APPA) or palonosetron (PA) alone, to prevent chemotherapy-induced nausea and vomiting (CINV) in patients undergoing treatment with highly or moderately emetogenic chemotherapy (HEC or MEC) in the UK.
  
  
  METHODS
  A systematic literature review and meta-analysis were undertaken to compare NEPA with currently recommended anti-emetics. Relative effectiveness was estimated over the acute (day 1) and overall treatment (days 1-5) phases, taking complete response (CR, no emesis and no rescue medication) and complete protection (CP, CR and no more than mild nausea [VAS scale <25 mm]) as primary efficacy outcomes. A three-health-state Markov cohort model, including CP, CR and incomplete response (no CR) for HEC and MEC, was constructed. A five-day time horizon and UK NHS perspective were adopted. Transition probabilities were obtained by combining the response rates of CR and CP from NEPA trials and odds ratios from the meta-analysis. Utilities of 0.90, 0.70 and 0.24 were defined for CP, CR and incomplete response, respectively. Costs included medications and management of CINV-related events and were obtained from the British National Formulary and NHS Reference Costs. The expected budgetary impact of NEPA was also evaluated.
  
  
  RESULTS
  In HEC patients, the NEPA strategy was more effective than APPA (quality-adjusted life days [QALDs] of 4.263 versus 4.053; incremental emesis-free and CINV-free days of +0.354 and +0.237, respectively) and was less costly (£80 versus £124), resulting in NEPA being the dominant strategy. In MEC patients, NEPA was cost effective, cumulating in an estimated 0.182 extra QALDs at an incremental cost of £6.65 compared with PA.
  
  
  CONCLUSIONS
  Despite study limitations (study setting, time horizon, utility measure), the results suggest NEPA is cost effective for preventing CINV associated with HEC and MEC in the UK.
authors.affiliation: MAPI Group, Nanterre, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Cawston
authors.affiliation: MAPI Group, Nanterre, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Bourhis
authors.affiliation: MAPI Group, Stockholm, Sweden.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Eriksson
authors.affiliation: Helsinn Healthcare SA, Lugano/Pazzallo, Switzerland.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Ruffo
authors.affiliation: Helsinn Healthcare SA, Lugano/Pazzallo, Switzerland.
authors.forename: Paolo
authors.initials: P
authors.lastname: D'Agostino
authors.affiliation: Helsinn Healthcare SA, Lugano/Pazzallo, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Turini
authors.affiliation: The West Clinic, Memphis, TN, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Schwartzberg
authors.affiliation: London School of Economics, London, UK.
authors.forename: Alistair
authors.initials: A
authors.lastname: McGuire
keywords: antiemetics; cost-effectiveness; medical oncology; meta-analysis; nausea; netupitant; palonosetron; quality of life; review literature; vomiting