Cost-effectiveness analysis of oral ondansetron and prochlorperazine for preventing nausea and vomiting after moderately emetogenic chemotherapy.

The article reports a study comparing the cost-effectiveness of ondansetron tablets and prochlorperazine capsules in preventing nausea and vomiting after moderately emetogenic chemotherapy in an outpatient setting. A decision analysis model was constructed to compare the cost-effectiveness of the two antiemetics from the perspective of third party health care payers. Probability estimates of the model were derived from a reanalysis of data obtained from a clinical trial directly comparing the two antiemetics. Effectiveness was defined as the number of patients with no emetic episodes and no drug-related adverse events during the 3-day period after receiving chemotherapy. Cost-estimates were based on Average Wholesale Price for medications and national average for hospital services adjusted to 1996 U.S. dollars. Cost-effectiveness ratios for ondansetron and prochlorperazine were $261 and $268 per effectively treated patient, respectively. A series of sensitivity analyses were performed to identify the limits of generalizability of study results. Despite the initial price differential between the two antiemetics, ondansetron was more cost effective than prochlorperazine when the duration of therapy was shorter than 3 days, the total cost of rescue therapy per patient was more than $71, the treatment cost of adverse events was less than $24, the complete relief rate for ondansetron was greater than 58.9 percent, and the complete relief rate for prochlorperazine was less than 26.5 percent.