Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Nausea | Research article

Cost-utility analysis of palonosetron in the antiemetic regimen for cisplatin-containing highly emetogenic chemotherapy in Japan

Authors: Munenobu Kashiwa, Ryo Matsushita

Published in: BMC Health Services Research | Issue 1/2019

Login to get access

Abstract

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.
Literature
1.
Hesketh PJ, Kris MG, Basch E, Bohlke K, Barbour SY, Clark-Snow RA, et al. Antiemetics: American Society of Clinical Oncology clinical practice guideline update. JCO. 2017;35:3240–61.CrossRef
2.
Berger MJ, Ettinger DS, Aston J, Barbour S, Bergsbaken J, Bierman PJ, et al. NCCN guidelines insights: Antiemesis, version 2.2017. J Natl Compr Canc Netw. Harborside Press, LLC. 2017;15:883–93.CrossRef
3.
Roila F, Molassiotis A, Herrstedt J, Aapro M, Gralla RJ, Bruera E, et al. 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol. 2016;27:v119–33.CrossRef
4.
Takeuchi H, Saeki T, Aiba K, Tamura K, Aogi K, Eguchi K, et al. Japanese Society of Clinical Oncology clinical practice guidelines 2010 for antiemesis in oncology: executive summary. Int J Clin Oncol. Springer Japan. 2015;21:1–12.CrossRef
5.
Oo TH, Hesketh PJ. Drug insight: new antiemetics in the management of chemotherapy-induced nausea and vomiting. Nat Clin Prac Oncol. Nature Publishing Group. 2005;2:196–201.CrossRef
6.
Saito M, Aogi K, Sekine I, Yoshizawa H, Yanagita Y, Sakai H, et al. Palonosetron plus dexamethasone versus granisetron plus dexamethasone for prevention of nausea and vomiting during chemotherapy: a double-blind, double-dummy, randomised, comparative phase III trial. Lancet Oncol. 2009;10:115–24.CrossRef
7.
Suzuki K, Yamanaka T, Hashimoto H, Shimada Y, Arata K, Matsui R, et al. Randomized, double-blind, phase III trial of palonosetron versus granisetron in the triplet regimen for preventing chemotherapy-induced nausea and vomiting after highly emetogenic chemotherapy: TRIPLE study. Ann Oncol. 2016;27:1601–6.CrossRef
8.
Kolesar JM, Eickhoff J, Vermeulen LC. Serotonin type 3-receptor antagonists for chemotherapy-induced nausea and vomiting: therapeutically equivalent or meaningfully different? Am J Health Sys Pharm. 2014;71:507–10.CrossRef
9.
10.
Du Q, Zhai Q, Zhu B, Xu X-L, Yu B. Economic evaluation of 5-HT3 receptor antagonists in combination with dexamethasone for the prevention of “overall” nausea and vomiting following highly emetogenic chemotherapy in Chinese adult patients. J Oncol Pharm Pract. 2016;23:403–12.CrossRef
11.
Shimizu H, Suzuki K, Uchikura T, Tsuji D, Yamanaka T, Hashimoto H, et al. Economic analysis of palonosetron versus granisetron in the standard triplet regimen for preventing chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy in Japan (TRIPLE phase III trial). J Pharm Health Care Sci. 2018;4(1):31.
12.
Susan Moore MDM, BA JT, Steven Wojtanowski RPM, Christopher Flowers MDMS. Cost-effectiveness of Aprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with highly Emetogenic chemotherapy. Value Health. International Society for Pharmacoeconomics and Outcomes Research (ISPOR). 2007;10:23–31.CrossRef
13.
Humphreys S, Pellissier J, Jones A. Cost-effectiveness of an aprepitant regimen for prevention of chemotherapy-induced nausea and vomiting in patients with breast cancer in the UK. Cancer Manag Res. 2013;5:215–24.
14.
Annemans L, Strens D, Lox E, Petit C, Malonne H. Cost-effectiveness analysis of aprepitant in the prevention of chemotherapy-induced nausea and vomiting in Belgium. Support Care Cancer. 2007;16:905–15.CrossRef
15.
National Health Insurance Drug Price Standard. Drug price standard score chart April, 2018 version. Tokyo, Japan Social Insurance Research Laboratory; 2018.
16.
Reimbursement Schedule of Social Insurance. Medical treatment fee score chart April, 2018 version. Tokyo, Japan Social Insurance Research Laboratory; 2018.
17.
Tamura K, Aiba K, Saeki T, Nakanishi Y, Kamura T, Baba H et al. Breakthrough chemotherapy-induced nausea and vomiting: report of a nationwide survey by the CINV Study Group of Japan. Int J Clini Oncol. 2016;1:1–8.
18.
Oshima Y, Ban A, et al. Pharmacoeconomic evaluation of low dose steroids for delayed nausea due to anticancer chemotherapy. J Jpn Soc Hosp Pharm. 2009;45:365–8.
19.
Yamanishi Y, Tajima H, et al. Cost-Eectiveness Analysis of 5-HT3 Receptor Antagonist Drug: Palonosetron in Cancer Chemotherapy. Jpn J Pharm Palliat Care Sci. 2014;7(2):37–43.
20.
Sun CC, Bodurka DC, Weaver CB, Rasu R, Wolf JK, Bevers MW, et al. Rankings and symptom assessments of side effects from chemotherapy: insights from experienced patients with ovarian cancer. Support Care Cancer. Springer-Verlag. 2004;13:219–27.CrossRef
21.
Lordick F, Ehlken B, Ihbe-Heffinger A, Berger K, Krobot KJ, Pellissier J, et al. Health outcomes and cost-effectiveness of aprepitant in outpatients receiving antiemetic prophylaxis for highly emetogenic chemotherapy in Germany. Eur J Cancer. 2007;43:299–307.CrossRef
22.
Tsukiyama I, Hasegawa S, Ikeda Y, Takeuchi M, Tsukiyama S, Kurose Y, et al. Cost-effectiveness of aprepitant in Japanese patients treated with cisplatin-containing highly emetogenic chemotherapy. Cancer Sci. 2018;109:2881–8.CrossRef
23.
24.
Fukuda T, Shiroiwa T, Ikeda S, et al. Guideline for economic evaluation of healthcare technologies in Japan. [in Japanese]. J Natl Inst Public Health. 2013;62:625–40.
25.
Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. Clin Ther. Elsevier Inc. 2013;35:356–63.CrossRef
26.
Shiroiwa T, Sung Y-K, Fukuda T, Lang H-C, Bae S-C, Tsutani K. International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness? Health Econ. John Wiley & Sons, Ltd. 2010;19:422–37.CrossRef
27.
Cawston H, Bourhis F, Eriksson J, Ruffo P, Di'Agostino P, Turini M, et al. NEPA, a new fixed combination of netupitant and palonosetron, is a cost-effective intervention for the prevention of chemotherapy-induced nausea and vomiting in the UK. DIC. 2017;6:1–13.CrossRef
28.
Restelli U, Saibene G, Nardulli P, Di Turi R, Bonizzoni E, Scolari F, et al. Cost-utility and budget impact analyses of the use of NEPA for chemotherapy-induced nausea and vomiting prophylaxis in Italy. BMJ Open. 2017;7:e015645–9.CrossRef
Metadata
Title
Cost-utility analysis of palonosetron in the antiemetic regimen for cisplatin-containing highly emetogenic chemotherapy in Japan
Authors
Munenobu Kashiwa
Ryo Matsushita
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4281-0

Other articles of this Issue 1/2019

BMC Health Services Research 1/2019 Go to the issue

Research article

Is antibacterial treatment intensity lower in elderly patients? A retrospective cohort study in a German surgical intensive care unit

Study protocol

A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial

Research article

Perceptions on the feasibility of decentralizing phlebotomy services in community anti-retroviral therapy group model in Lusaka, Zambia

Research article

A self-reported measurement scale on a potential component of competency in the healthcare staff engaged in the prevention and control of non-communicable disease in Fiji

Research article

Cross-cultural adaptation, internal consistency, test-retest reliability and feasibility of the German version of the evidence-based practice inventory

Research article

Use of prescription medication prior to suicide in Norway