Plosker G L, Milne R J
Adis International Limited, Auckland, New Zealand.
Pharmacoeconomics. 1992 Oct;2(4):285-304. doi: 10.2165/00019053-199202040-00005.
Ondansetron is more effective than high-dose metoclopramide in the prevention of acute nausea and vomiting due to highly emetogenic chemotherapy, and, unlike metoclopramide, is rarely associated with extrapyramidal effects. Pharmacoeconomic analyses have demonstrated that, in specified clinical settings, ondansetron (8mg 4-hourly for 3 doses or 8mg followed by 1 mg/h for 24 hours) is equally cost-effective as high-dose metoclopramide (3 mg/kg followed by 0.5 mg/kg/h for 8 hours) in the prophylaxis of emesis in patients receiving highly emetogenic chemotherapy, at an acquisition cost 4- or 5-fold higher than that of the metoclopramide regimen. Furthermore, the combination of dexamethasone plus ondansetron has been shown to be more effective than ondansetron monotherapy in controlling emesis. In patients receiving high-dose ( greater than 50 mg/m2) cisplatin-based chemotherapy, antiemetic therapy with ondansetron (8mg intravenously as a single dose) plus dexamethasone (16mg total intravenous dose) was shown to be more cost-effective than the combination of high-dose metoclopramide (11 mg/kg total intravenous dose), dexamethasone (8mg intravenously as a single dose) plus lorazepam (1 to 1.5mg intravenously as a single dose). In a limited number of studies, quality-of-life scores, as assessed using the Rotterdam Symptom Checklist or the Functional Living Index--Emesis instrument, were significantly higher with ondansetron than with other antiemetic agents, including metoclopramide. Together, these results suggest that ondansetron, as an alternative to antiemetic regimens including high-dose metoclopramide, is appropriate cost-effective therapy for the prevention of acute nausea and vomiting in patients receiving highly emetogenic chemotherapy. Ondansetron is effective in controlling acute emesis associated with moderately emetogenic chemotherapy, and its use in this clinical setting may best be reserved for patients who have not responded well to previous antiemetic therapy with more traditional agents. However, poorly controlled emesis can lead to anticipatory nausea and vomiting in subsequent courses of chemotherapy, thus, consideration should also be given to the use of ondansetron in patients receiving moderately emetogenic chemotherapy, although further pharmacoeconomic investigations are required to clarify its use in this clinical setting.
昂丹司琼在预防因高致吐性化疗引起的急性恶心和呕吐方面比大剂量甲氧氯普胺更有效，而且与甲氧氯普胺不同，它很少引起锥体外系反应。药物经济学分析表明，在特定临床环境中，昂丹司琼（8毫克，每4小时1次，共3剂；或8毫克后以1毫克/小时持续24小时）在预防接受高致吐性化疗患者的呕吐方面与大剂量甲氧氯普胺（3毫克/千克，后以0.5毫克/千克/小时持续8小时）具有同等成本效益，但其购置成本比甲氧氯普胺方案高4至5倍。此外，地塞米松加昂丹司琼的联合用药在控制呕吐方面已被证明比昂丹司琼单药治疗更有效。在接受高剂量（大于50毫克/平方米）顺铂为基础的化疗患者中，昂丹司琼（8毫克静脉注射单剂）加地塞米松（总静脉剂量16毫克）的止吐治疗已被证明比大剂量甲氧氯普胺（总静脉剂量11毫克/千克）、地塞米松（8毫克静脉注射单剂）加劳拉西泮（1至1.5毫克静脉注射单剂）的联合用药更具成本效益。在少数研究中，使用鹿特丹症状清单或功能性生活指数-呕吐量表评估的生活质量评分，昂丹司琼组显著高于包括甲氧氯普胺在内的其他止吐药物组。总之，这些结果表明，昂丹司琼作为包括大剂量甲氧氯普胺在内的止吐方案的替代药物，是预防接受高致吐性化疗患者急性恶心和呕吐的合适的具有成本效益的治疗方法。昂丹司琼在控制与中度致吐性化疗相关的急性呕吐方面有效，在这种临床环境中使用它最好留给那些对先前使用更传统药物的止吐治疗反应不佳的患者。然而，呕吐控制不佳可导致后续化疗疗程中出现预期性恶心和呕吐，因此，对于接受中度致吐性化疗的患者也应考虑使用昂丹司琼，尽管需要进一步的药物经济学研究来阐明其在这种临床环境中的应用。
