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Chemotherapy-induced nausea and vomiting (CINV) remains a major adverse effect of cancer chemotherapy which may increase morbidity, reduce quality of life and threaten the success of cancer therapy. Aprepitant is effective in preventing CINV, achieving higher complete response (no emesis and no rescue therapy) compared to standard prevention, in pa...
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Citations
... Utilities of 0.90 (95% CI 0.68-1.00) [9], 0.70 (95% CI 0.53-0.88) [9] and 0.27 (95% CI 0.18-0.30) ...
... [9], 0.70 (95% CI 0.53-0.88) [9] and 0.27 (95% CI 0.18-0.30) [21] were used for CP, CR and no CR, respectively. ...
Purpose
The aim of this study was to assess the cost-effectiveness of NEPA, a fixed-dose combination of oral netupitant (300 mg) and palonosetron (0.5 mg), compared to available treatments in Spain after aprepitant generic introduction in the market, and to discuss results in previously performed analyses in different wordwide settings.
Methods
A Markov model including three health states, complete protection, complete response at best and incomplete response, was used to evaluate the cost-effectiveness of NEPA versus common treatment options in Spain during 5 days after chemotherapy. Incremental costs including treatment costs and treatment failure management cost as well as incremental effects including quality adjusted life days (QALDs) and emesis-free days were compared between NEPA and the comparator arms. The primary outcomes were cost per avoided emetic event and cost per QALDs gained.
Results
NEPA was dominant (more effective and less costly) against aprepitant combined with palonosetron, and fosaprepitant combined with granisetron, while, compared to generic aprepitant plus ondansetron, NEPA showed an incremental cost per avoided emetic event of €33 and cost per QALD gained of €125.
Conclusion
By most evaluations, NEPA is a dominant or cost-effective treatment alternative to current antiemetic standards of care in Spain during the first 5 days of chemotherapy treatment in cancer patients, despite the introduction of generics. These results are in line with previously reported analyses throughout different international settings.
... Since 2007, studies have been conducted in seven countries to evaluate the economic value of prophylactic antiemetic regimens (19)(20)(21)(22)(23)(24). Most of them showed favorable results with APR. ...
Objective
The purpose of this study was to evaluate the cost-effectiveness and budget impact of fosaprepitant (FosAPR)-containing regimen for the prevention of chemotherapy-induced nausea and vomiting (CINV) among patients receiving high emetogenic chemotherapy (HEC) from the Chinese payer's perspective.
Methods
A decision tree model was established to measure the 5-day costs and health outcomes between the APR-containing regimen (aprepitant, granisetron, and dexamethasone) and FosAPR-containing regimen (fosaprepitant, granisetron, and dexamethasone). Clinical data were derived from a randomized, double-blind controlled trial on Chinese inpatients who received HEC. Quality-adjusted life-years (QALYs) were used to estimate the utility outcomes and the incremental cost-effectiveness ratio (ICER) was calculated to assess the economics of FosAPR. A static budget impact model was developed to assess the impact of FosAPR as a new addition to the National Reimbursement Drug List (NRDL) on the medical insurance fund within 3 years in Nanjing, China.
Results
Compared with APR, FosAPR had a mean health-care savings of ¥121.56 but got a reduction of 0.0001815 QALY, resulting in an ICER of ¥669926.19 per QALY. Deterministic sensitivity analysis revealed that the cost of APR was the most influential factor to the ICER. The cost of FosAPR and the complete control rate of the delayed period also had a high impact on the results. According to the probabilistic analysis, the acceptability of FosAPR was more than 80% when the Chinese willingness-to-pay (WTP) was ¥215,999. FosAPR would lead to a 3-year medical insurance payment increase of ¥1.84 million compared with ¥1.49 million before FosAPR entered NRDL in Nanjing. The total budget increased with a cumulative cost of ¥694,829 and covered an additional 341 patients who benefited from FosAPR in Nanjing. Deterministic sensitivity analysis showed that the model of budget impact analysis was stable.
Conclusion
FosAPR had a similar treatment effect to APR but was cost-effective in China at the current WTP threshold. The total budget of medical insurance payments of Nanjing slightly increased year by year after the inclusion of FosAPR. Its inclusion in the NRDL would be acceptable and also expand the coverage of patients who benefited from FosAPR.
... 16 The incremental cost of the aprepitant-based regimen versus a regimen of ondansetron and dexamethasone to gain 1 QALY for adults receiving HEC was found to be $30,700 in Hong Kong, $40,600 in Singapore, $14,757 in the United Kingdom, and $97,429in the United States.[32][33][34][35] In fact, two prior studies from Belgium and Italy demonstrated that the use of aprepitant is not only cost-effective rather cost saving.36,37 The differences in the cost-effectiveness estimates are partly due to variations in the costs of hospitalization and partly due to differences in the comparator regimens used in the analysis. ...
Background:
Aprepitant has been shown to reduce chemotherapy-induced nausea and vomiting in children receiving highly emetogenic chemotherapy (HEC). In this study, we assessed the cost-effectiveness of aprepitant for children receiving HEC in India, United Kingdom, and the United States.
Procedure:
We utilized individual patient-level outcome data from a pediatric randomized trial, which demonstrated the superiority of an aprepitant-based anti-emetic prophylaxis over standard ondansetron and dexamethasone for HEC. Health state for each day of follow-up was analyzed and quality-adjusted life years (QALYs) were estimated. The incremental cost-utility ratio (ICUR), incremental cost-effectiveness ratio (ICER), and net monetary benefit (NMB) for each country were estimated. Sensitivity analyses by varying cost of aprepitant, hospitalization, and health state utility values by ±25% were conducted.
Results:
Use of the aprepitant-based regimen resulted in gain of 0.0019 QALY per chemotherapy cycle along with cost savings of $22.25, $1335.52, and $6612.10 for India, United Kingdom, and the United States, respectively. The cost savings per QALY was estimated to be $12,355.84 for India, $734,282.90 for the United Kingdom, and $3,567,564.11 for the United States. The cost savings for 50% gain in the percentage of days without grade 3 vomiting was $124.18 for India, $7451.63 for the United Kingdom, and $36,892.76 for the United States. The NMB for gain in QALY was $33.62, $1418.60, and $6727.01 for India, United Kingdom, and the United States, respectively. The estimates remained cost-effective across all scenarios of the sensitivity analyses.
Conclusion:
Aprepitant-based anti-emetic regimen is cost-effective for children receiving HEC. It results in overall cost savings and reduced healthcare-resource utilization.
... After a thorough search of the databases, we acquired 169 articles, of which 104 were excluded based on the title and abstract screening. A total of 13 published studies (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) were selected for final inclusion (Figure 1) after reviewing. Table 1 describes the general characteristics of the included studies. ...
... Table 1 describes the general characteristics of the included studies. Of the 13 studies, eight (18,(21)(22)(23)(24)(25)(26)30) conducted both cost-effectiveness analysis (CEA) and cost-utility analysis (CUA), two studies conducted CUA (19,20), one study conducted CEA (27), one study conducted cost-consequences analysis (CCA) (28), and one study conducted both CUA and budget impact analysis (29). ...
... Eleven studies were conducted from a payer perspective, of which eight were performed from a public payer perspective (e.g., National Health Service, National Health Insurance system, and health-care system) (18,20,21,23,24,(28)(29)(30). In contrast, one study used a patient and statutory health insurance perspective (25), and two studies used the perspective of the payer, but did not describe it specifically (19,26). ...
Objectives: The aim of this systematic review is to assess the published cost-effectiveness analyses of aprepitant for patients with chemotherapy-induced nausea and vomiting (CINV).
Methods: A systematic literature search was performed on PubMed, EMbase, the Cochrane Library, CNKI, WANFANG DATA, and CBM database. The date of publication is up to January 2019. Two reviewers independently reviewed titles, abstracts, and articles sequentially to select studies for data abstraction based on the inclusion and exclusion criteria. Disagreements were resolved and reviewers reached a consensus. The quality of the included studies was assessed according to the 24-item checklist of the consolidated health economic evaluation reporting standards (CHEERS). The costs reported by the included studies were converted to US dollars via purchasing power parities (PPP) in the year 2019 using the CCEMG–EPPI–Certer Cost Converter.
Results: Thirteen articles were included based on the inclusion criteria for cost-effectiveness analysis and cost-utility analysis. Twelve studies were rated as good quality and one as a moderate quality based on the CHEERS checklist. Eight studies compared aprepitant plus 5-hydroxytryptamine-3 receptor antagonist (5-HT3RA) and dexamethasone with the standard regimen (5-HT3RA and dexamethasone). It was concluded that aprepitant plus standard regimen was a cost-effective strategy for preventing CINV. Only one study that compared aprepitant plus 5-HT3RA with 5-HT3RA, concluded that the addition of aprepitant reduced the incidence of severe nausea, and it might also provide an economic benefit in the overall management. Four studies that compared aprepitant with other antiemetic drugs concluded that aprepitant is a cost-effective strategy for preventing CINV compared with metoclopramide. However, netupitan + palonosetron and olanzapine are cost-effective compared with aprepitant.
Conclusion: This study is the first systematic evaluation of adding aprepitant to standard regimens for patients with CINV. Most economic evaluations of antiemetic medications are reported to be of good quality. Adding aprepitant to standard regimens is found to be a cost-effective strategy for preventing CINV.
... For 31 countries, their hospital care costs were directly stated; 7,17,41,78,82,89,91,97,99,103,105,109,110,111,113,118,121,125,128,131,134,137,139,141,145 Two countries listed their oncology budgets for hospital cancer care -Estonia and Icelandtheir prevalence rate of CRC amongst all cancers was used to calculate CRC outpatient care costs. 24,37 All costs were expressed in local currency units and inflated/deflated to 2015 employing, harmonised indices of consumer prices to balance inflation for hospital services in the euro area, the EU, the European Economic Area and for other countries, including accession and candidate countries. ...
Background
Colorectal cancer is one of the leading causes of cancer morbidity and mortality in Europe. We aimed to ascertain the economic burden of colorectal cancer across Europe using a population-based cost-of-illness approach.
Methods
In this population-based cost-of-illness study, we obtained 2015 activity and costing data for colorectal cancer in 33 European countries (EUR-33) from global and national sources. Country-specific aggregate data were acquired for health-care, mortality, morbidity, and informal care costs. We calculated primary, outpatient, emergency, and hospital care, and systemic anti-cancer therapy (SACT) costs, as well as the costs of premature death, temporary and permanent absence from work, and unpaid informal care due to colorectal cancer. Colorectal cancer health-care costs per case were compared with colorectal cancer survival and colorectal cancer personnel, equipment, and resources across EUR-33 using univariable and multivariable regression. We also compared hospital care and SACT costs against 2009 data for the 27 EU countries.
Findings
The economic burden of colorectal cancer across Europe in 2015 was €19·1 billion. The total non-health-care cost of €11·6 billion (60·6% of total economic burden) consisted of loss of productivity due to disability (€6·3 billion [33·0%]), premature death (€3·0 billion [15·9%]), and opportunity costs for informal carers (€2·2 billion [11·6%]). The €7·5 billion (39·4% of total economic burden) of direct health-care costs consisted of hospital care (€3·3 billion [43·4%] of health-care costs), SACT (€1·9 billion [25·6%]), and outpatient care (€1·3 billion [17·7%]), primary care (€0·7 billion [9·3%]), and emergency care (€0·3 billion [3·9%]). The mean cost for managing a patient with colorectal cancer varied widely between countries (€259–36 295). Hospital-care costs as a proportion of health-care costs varied considerably (24·1–84·8%), with a decrease of 21·2% from 2009 to 2015 in the EU. Overall, hospital care was the largest proportion (43·4%) of health-care expenditure, but pharmaceutical expenditure was far higher than hospital-care expenditure in some countries. Countries with similar gross domestic product per capita had widely varying health-care costs. In the EU, overall expenditure on pharmaceuticals increased by 213·7% from 2009 to 2015.
Interpretation
Although the data analysed include non-homogenous sources from some countries and should be interpreted with caution, this study is the most comprehensive analysis to date of the economic burden of colorectal cancer in Europe. Overall spend on health care in some countries did not seem to correspond with patient outcomes. Spending on improving outcomes must be appropriately matched to the challenges in each country, to ensure tangible benefits. Our results have major implications for guiding policy and improving outcomes for this common malignancy.
Funding
Department for Employment and Learning of Northern Ireland, Medical Research Council, Cancer Research UK, Health Data Research UK, and DATA-CAN.
... They also stated that aprepitant was cost-effective only when the frequent delayed CINV required costly rescue medications. Other studies from Belgium, the UK, Hong Kong, and Singapore consistently concluded that aprepitant was cost-effective, using the decision-analytic model based on phase III trials of aprepitant [16,[18][19][20][21]. We also recently reported that the cost-effectiveness of aprepitant was limited in the outpatient care setting, based on a randomized phase II trial of aprepitant in Japan [22]. ...
... Aprepitant was also more cost-effective for patients who received HEC than for those who received MEC. The results of this study partly support previous reports of the costeffectiveness of aprepitant by Lordick et al. [16] in Germany, Humphreys et al. [18] in the UK, Annemans et al. [19] in Belgium, Lopes et al. [21] in Singapore, and Chan et al. [20] in Hong Kong. These reports all concluded that aprepitant showed superior cost-effectiveness in analyses using a decision-analytic model similar to that of the present study. ...
Purpose
Neurokinin-1 receptor antagonist (NK1RA) is recommended to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly or moderately emetogenic chemotherapy (HEC or MEC, respectively). We previously reported that aprepitant, an NK1RA, was needed to control CINV in 43% and 12% of patients who received HEC and MEC, respectively (Support Care Cancer 23:905–912, 2015). To elucidate the cost-effectiveness of aprepitant in these patients, a cost-utility analysis according to the necessity of aprepitant was performed.
Methods
A decision-analytic model was developed according to the necessity of aprepitant and CINV responses in both acute and delayed phases of chemotherapy. Probabilities of health states and medical costs were derived from the results of the abovementioned trial.
Result
In patients who received HEC and needed aprepitant, the incremental cost-effectiveness ratio (ICER) with aprepitant, relative to the regimen with no aprepitant, was 7912 US dollars (USD) per quality-adjusted life year (QALY) gained, which was far below the commonly accepted threshold of 50,000 USD/QALY. The ICER was 27,457 USD/QALY in patients who received MEC and needed aprepitant. In contrast, in patients who received HEC or MEC but did not need aprepitant, the ICER was 175,959 or 478,844 USD/QALY, respectively.
Conclusion
Regardless of whether a patient received HEC or MEC, aprepitant use was highly cost-effective for patients who truly needed it. These results warrant further research to predict the necessity of NK1RA treatment before initiating emetogenic chemotherapies.
... A decision tree that showed the acute phase and the delayed phase was constructed according to prior reports [12][13][14] to estimate and compare the health outcomes and cost of prophylactic antiemetic therapy using PALO (Fig. 1). The clinical outcome was defined as CR with no emesis and no rescue antiemetic therapy, and incomplete response (IR) was defined as some emesis or some use of rescue antiemetic therapy. ...
... Sun et al. report a QoL evaluation using a visual analog scale according to the presence or absence of CINV by chemotherapy [20]. Including this report, according to previous CINV reports [13,14,21,22], utility values were applied to the three health states. ...
Background:
An antiemetic triplet regimen of 5-hydrotryptamine-3 receptor antagonist, dexamethasone, and aprepitant is the standard prophylaxis with highly emetogenic chemotherapy (HEC). A randomized phase III trial comparing palonosetron (PALO) versus granisetron (GRA) in the triplet antiemetic regimen (The TRIPLE study) showed the superiority of PALO over GRA for delayed-phase vomiting in patients receiving cisplatin-based HEC. However, economic efficiency evaluations including quality of life have not been done. The present study was a cost-utility analysis of PALO within the Japanese medical insurance system.
Methods:
The data source was the results of the TRIPLE study. A decision tree was constructed to assess the incremental cost-effectiveness ratio (ICER) using quality-adjusted life years (QALYs) and the medical service fees and the drug price for 2018 from the perspective of the payer. A one-way sensitivity analysis and a probabilistic sensitivity analysis (PSA) were performed to assess the robustness of the model. A threshold analysis was performed to determine the cost-effective price of PALO.
Results:
In the base case, the estimated incremental effect of PALO addition was 0.000645 QALYs, the estimated incremental cost was 10,455 JPY (93.21 USD), and the ICER was 16,204,591 JPY QALY (144,465 USD/QALY). In the PSA, the probability of superior cost-effectiveness was 3.64%. In the threshold analysis, the acceptable price of PALO was estimated to be 7,743 JPY (69.03 USD).
Conclusions:
If willingness-to-pay is taken as 5,000,000 JPY/QALY (44,575 USD/QALY), the antiemetic regimen using PALO for cisplatin-containing HEC was not cost-effective at this time. The cost of drugs, with the arrival of inexpensive generic drugs, will make a major contribution to its cost-effectiveness.
... 9,10 In our previous experience, a significant proportion of patients who received 5-HT 3 antagonist monotherapy as antiemetic prophylaxis with adjuvant temozolomide (150-200 mg/m 2 ) had CINV. This uncontrolled CINV leads to a decrement in quality of life, 11 affects treatment compliance, 12 leads to unnecessary emergency visits, 13 increases treatment cost, 14,15 and, rarely, causes death. 13 Hence, to avoid temozolomide-induced CINV, we started exploring antiemetic combinations. ...
Background
In our previous experience, a significant proportion of patients who received 5-HT3 antagonist monotherapy with adjuvant temozolomide (150-200 mg/m²) had chemotherapy-induced nausea and vomiting (CINV). This is an audit comparing the multiple antiemetic therapies in the prevention of temozolomide-associated CINV.
Methods
This was a retrospective audit. Adult glioma patients treated with temozolomide at a dose of 150-200 mg/m² between October 2017 and June 2018 were selected for this analysis. Three antiemetic prophylaxis were used in this time period: ondansetron (October 2017 to November 2017), ondansetron + domperidone (December 2017 to February 2018), and ondansetron + olanzapine (March 2018 to June 2018). The rates of nausea and vomiting were compared among the 3 cohorts using the chi-squared test with Bonferroni correction. A P value of less than .016 was considered significant.
Results
A total of 360 patients were selected for this analysis. There were 91 patients in the ondansetron prophylaxis group (25.3%), 113 (31.4%) in the ondansetron plus domperidone group, and 156 (43.3%) in the ondansetron plus olanzapine group. The overall incidence of nausea and vomiting was 25.0% (n = 90) and 7.2% (n = 26). Overall the rates of nausea (P = .052) and vomiting (P = .481) were similar in all 3 cohorts. However, the rates of grade 2 and above nausea (P = .012) and vomiting (P = .015) were significantly lower in the olanzapine group.
Conclusion
The combination of ondansetron with olanzapine leads to a statistically significant decrease in the rate of moderate-to-severe emesis and nausea and needs to be explored in a prospective study.
... Aprepitant (APR), a neurokinin-1 (NK-1) RA, was developed in the 2000s (international birth date, March 2003) [2,3]. Several reports discussed the cost-effectiveness of NK-1 RAs [4][5][6][7][8]. Meanwhile, current antiemetic guidelines recommend a three-drug combination consisting of a 5-HT 3 RA, dexamethasone (DEX), and APR for patients receiving highly emetogenic chemotherapy (HEC) [9][10][11]. ...
Background:
We conducted an economic assessment using test data from the phase III TRIPLE study, which examined the efficacy of a 5-hydroxytryptamine 3 receptor antagonist as part of a standard triplet antiemetic regimen including aprepitant and dexamethasone in preventing chemotherapy-induced nausea and vomiting in patients receiving cisplatin-based highly emetogenic chemotherapy (HEC).
Methods:
We retrospectively investigated all medicines prescribed for antiemetic purposes within 120 h after the initiation of cisplatin administration during hospitalization. In the TRIPLE study, patients were assigned to treatment with granisetron (GRA) 1 mg (n = 413) or palonosetron (PALO) 0.75 mg (n = 414). The evaluation measure was the cost-effectiveness ratio (CER) assessed as the cost per complete response (CR; no vomiting/retching and no rescue medication). The analysis was conducted from the public healthcare payer's perspective.
Results:
The CR rates were 59.1% in the GRA group and 65.7% in the PALO group (P = 0.0539), and the total frequencies of rescue medication use for these groups were 717 (153/413 patients) and 573 (123/414 patients), respectively. In both groups, drugs with antidopaminergic effects were chosen as rescue medication in 86% of patients. The costs of including GRA and PALO in the standard triplet antiemetic regimen were 15,342.8 and 27,863.8 Japanese yen (JPY), respectively. In addition, the total costs of rescue medication use were 73,883.8 (range, 71,106.4-79,017.1) JPY for the GRA group and 59,292.7 (range, 57,707.5-60,972.8) JPY for the PALO group. The CERs (JPY/CR) were 26,263.4 and 42,628.6 for the GRA and PALO groups, respectively, and the incremental cost-effectiveness ratio (ICER) between the groups was 189,171.6 (189,044.8-189,215.5) JPY/CR.
Conclusions:
We found that PALO was more expensive than GRA in patients who received a cisplatin-based HEC regimen.
... The aprepitant regimen consisted of the 3-drug combination of aprepitant, a 5-HT 3 RA and dexamethasone (Table 1), which corresponded to antiemetic regimens recom- complete response (CR) with no emesis and no rescue antiemetic therapy, and incomplete response (IR) with some emesis or use of rescue therapy. CR was further subdivided into 2 mutually exclusive health outcomes: (a) complete protection (CP) with no emesis, no rescue therapy and no significant nausea; (b) complete response at best (CRB) with no emesis and no rescue therapy excluding CP. [17][18][19][20][21] The probabilities of predicting the outcomes from one health state to another were determined using the data from the clinical trial results (Table 2). 15 Duration of aprepitant administration was assumed to be 3 days according to the common practical use of aprepitant derived from Protocol 052. ...
... QALY in each treatment group was integrated according to the probability of the health state in the acute phase and in the delayed phase. A utility value of each health state was assigned according to the previous reports, [17][18][19][20] and utility values of 0.9, 0.7 and 0.2 were assigned to CP, CRB, and IR, respectively. ...
... Humphreys et al 18 showed that aprepitant was cost-effective in anthracycline-cyclophosphamidebased chemotherapy from the British National Health Service (NHS) perspective. Annemans et al in Belgium, Chan et al in Hong Kong, and Lopes et al in Singapore reported consistently better results, with aprepitant cost-effective in both cisplatin and anthracyclinecyclophosphamide-based chemotherapy in each national health system.[19][20][21] Reports from Germany and Hong Kong noted that the analyses were conducted in the OCS.17,20 ...
Chemotherapy‐induced nausea and vomiting (CINV) remains a major adverse event in cancer chemotherapy. While aprepitant is effective in preventing CINV, an increment in financial burden for uniform use of aprepitant is a concern. The aim of this study is to define the cost‐effectiveness of aprepitant from the perspective of the Japanese National Health Insurance system. Based on the results of a randomized phase II trial comparing an aprepitant‐containing regimen versus a non‐aprepitant regimen in Japanese patients who received cisplatin‐containing highly emetogenic chemotherapy, a decision analytic model was developed. The incremental cost‐effectiveness ratio (ICER) was calculated both in the outpatient care setting (OCS) and in the inpatient care setting (ICS). The use of the aprepitant‐containing regimen was associated with improved quality of life compared with the non‐aprepitant regimen, with an increment in quality‐adjusted‐life‐years (QALYs) of 0.0016. The incremental total medical costs associated with the use of the aprepitant regimen were lower in the OCS than in the ICS, 6,192 JPY (56.92 USD) and 9,820 JPY (90.27 USD), respectively. The ICER was calculated as 3,906,698 JPY (35,910 USD) per QALY gained in the OCS and 6,195,781 JPY (56,952 USD) per QALY gained in the ICS. The cost‐effectiveness of the aprepitant‐containing antiemetic therapy was limited to the OCS, considering the threshold of willingness‐to‐pay commonly accepted (5 million JPY (45,960 USD) in Japan and 50,000 USD in the US). The efficacy of aprepitant offset the costs for revisiting clinics or re‐hospitalization added with rescue medications in the OCS.
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