Watcha M F, Smith I
Department of Anesthesiology and Pain Management, University of Texas, Southwestern Medical Center at Dallas 75235-9068.
J Clin Anesth. 1994 Sep-Oct;6(5):370-7. doi: 10.1016/s0952-8180(05)80006-6.
To compare the relative cost-effectiveness ratios of (1) therapy with ondansetron, droperidol, and metoclopramide in the prevention of postoperative nausea and vomiting (PONV), and (2) prophylactic versus rescue therapy of PONV with these agents.
Cost-effectiveness analysis based on the estimated costs of 12 mutually exclusive outcomes identified by decision analysis.
Computer model of outcome established using data extracted from published studies and a survey of current practice in two university-affiliated hospitals.
Patients undergoing operations associated with a high risk of PONV.
The cost-effectiveness of prophylactic antiemetic therapy was compared among three drugs and also compared with limiting treatment to established PONV.
Direct costs included drug acquisition, drug delivery, equipment used in managing vomiting, and additional nursing time costs. Indirect costs included drugs and materials used to treat persistent nausea and/or vomiting and the side effects of prophylactic drugs, increased time spent in the postanesthesia care unit, unanticipated hospitalization, and lost earnings due to hospitalization. Separate models were created for patients with both nausea and vomiting and with isolated nausea. The total incremental costs associated with the prophylactic use of ondansetron, metoclopramide, and droperidol were $37.74, $28.43, and $18.17 per patient, respectively. The costs per emesis-free patient with the prophylactic use of ondansetron, metoclopramide, and droperidol, were $55.91, $71.08, and $30.15, respectively, and per nausea-free patient $68.93, $82.74, and $33.52, respectively. Prophylactic antiemetic therapy was cost-effective for operations with a high frequency of emesis, whereas treatment of established symptoms was more cost-effective when the frequency was lower. For ondansetron, prophylactic use was cost-effective only when the frequency of emesis exceeded 33%, whereas prophylactic droperidol was cost-effective even if the frequency was 10%.
When drug costs, efficacy, and adverse events were all considered, prophylactic droperidol was more cost-effective than ondansetron, and both drugs were more cost-effective than metoclopramide. However, the expected frequency of PONV, as well as local drug acquisition costs, can significantly influence whether a particular antiemetic is cost-effective when given prophylactically or only as therapy for established PONV.
比较（1）昂丹司琼、氟哌利多和甲氧氯普胺预防术后恶心和呕吐（PONV）的相对成本效益比，以及（2）这些药物对PONV的预防性治疗与补救性治疗。
基于决策分析确定的12种相互排斥结果的估计成本进行成本效益分析。
使用从已发表研究中提取的数据和对两家大学附属医院当前实践的调查建立结果的计算机模型。
接受与PONV高风险相关手术的患者。
比较三种药物预防性止吐治疗的成本效益，并与将治疗限于已发生的PONV进行比较。
直接成本包括药物采购、药物给药、处理呕吐所用设备以及额外的护理时间成本。间接成本包括用于治疗持续性恶心和/或呕吐以及预防性药物副作用的药物和材料、在麻醉后护理单元花费的额外时间、意外住院以及因住院导致的收入损失。针对同时有恶心和呕吐以及仅有恶心的患者分别创建模型。预防性使用昂丹司琼、甲氧氯普胺和氟哌利多的总增量成本分别为每位患者37.74美元、28.43美元和18.17美元。预防性使用昂丹司琼、甲氧氯普胺和氟哌利多时，每位无呕吐患者的成本分别为55.91美元、71.08美元和30.15美元，每位无恶心患者的成本分别为68.93美元、82.74美元和33.52美元。预防性止吐治疗对于呕吐频率高的手术具有成本效益，而当频率较低时，治疗已出现的症状更具成本效益。对于昂丹司琼，仅当呕吐频率超过33%时预防性使用才具有成本效益，而预防性使用氟哌利多即使频率为10%时也具有成本效益。
当综合考虑药物成本、疗效和不良事件时，预防性使用氟哌利多比昂丹司琼更具成本效益，且这两种药物都比甲氧氯普胺更具成本效益。然而，PONV的预期频率以及当地药物采购成本，会显著影响某种特定止吐药在预防性给药或仅作为已发生PONV的治疗时是否具有成本效益。
