Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON, Canada.
Support Care Cancer. 2021 Aug;29(8):4269-4275. doi: 10.1007/s00520-020-05977-x. Epub 2021 Jan 7.
Olanzapine-containing regimens have been reported to be effective in preventing CINV following highly emetogenic chemotherapy (HEC), but it is unsure whether it is cost-effective. There has been no cost-effectiveness analysis conducted for olanzapine using costs from the USA. The aim of this study is to determine whether olanzapine-containing antiemetic regimens are cost-effective in patients receiving HEC.
A decision tree model was constructed to evaluate the cost and health outcomes associated with olanzapine-containing antiemetic regimens and otherwise-identical regimens. One-way sensitivity analyses were conducted to individually investigate the effect of (i) lower complete response (CR) rates of olanzapine, closer to non-olanzapine-containing regimens; (ii) higher FLIE scores for patients who achieved no/incomplete response, closer to FLIE scores of patients achieving a complete response; (iii) differing costs of olanzapine to reflect different costs per hospitals, globally, due to different insurance systems and drug costs; and (iv) varying costs for uncontrolled CINV, to account for varying durations of chemotherapy and accompanying uncontrolled CINV.
Olanzapine regimens have an expected cost of $325.24, compared with $551.23 for non-olanzapine regimens. Meanwhile, olanzapine regimens have an expected utility/index of 0.89, relative to 0.87 for non-olanzapine regimens. Olanzapine-containing regimens dominate non-olanzapine-containing regimens even if CR of olanzapine-containing regimens fall to 0.63. Only when CR is between 0.60 and 0.62 is olanzapine both more effective and more costly.
Olanzapine-containing regimens are both cheaper and more effective in the prophylaxis of CINV in HEC patients, compared with non-olanzapine-containing regimens. Future CINV trial resources should be allocated to understand newer antiemetics and compare them to olanzapine-containing regimens as the control arm. Further analysis should use nationally representative data to examine medication costs by payer type.
含奥氮平的方案已被报道在预防高度致吐化疗（HEC）后 CINV 方面是有效的，但它是否具有成本效益尚不确定。尚未使用来自美国的成本进行奥氮平的成本效益分析。本研究旨在确定在接受 HEC 的患者中，含奥氮平的止吐方案是否具有成本效益。
构建决策树模型，以评估含奥氮平的止吐方案与其他相同方案相关的成本和健康结果。进行了单因素敏感性分析，以单独研究以下因素的影响：（i）奥氮平较低的完全缓解（CR）率，更接近不含奥氮平的方案；（ii）未达到完全缓解或不完全缓解的患者的 FLIE 评分更高，更接近达到完全缓解的患者的 FLIE 评分；（iii）由于不同的保险制度和药物成本，奥氮平的成本差异反映了全球不同医院的成本差异；（iv）未控制的 CINV 的成本差异，以考虑化疗持续时间和伴随的未控制的 CINV 的持续时间不同。
奥氮平方案的预期成本为 325.24 美元，而非奥氮平方案的预期成本为 551.23 美元。同时，奥氮平方案的预期效用/指数为 0.89，而非奥氮平方案的预期效用/指数为 0.87。奥氮平方案优于非奥氮平方案，即使奥氮平方案的 CR 下降至 0.63。只有当 CR 在 0.60 到 0.62 之间时，奥氮平才更有效且更昂贵。
与不含奥氮平的方案相比，含奥氮平的方案在预防 HEC 患者的 CINV 方面更便宜且更有效。未来的 CINV 试验资源应分配给了解新的止吐药，并将其与奥氮平方案作为对照进行比较。进一步的分析应使用具有全国代表性的数据，按付款人类型检查药物成本。
