Cost-utility analysis of aprepitant for patients who truly need it in Japan View Full Text


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Article Info

DATE

2019-02-01

AUTHORS

Ikuto Tsukiyama, Masahiko Ando, Sumiyo Tsukiyama, Masayuki Takeuchi, Masayuki Ejiri, Yusuke Kurose, Hiroko Saito, Ichiro Arakawa, Tadao Inoue, Etsuro Yamaguchi, Akihito Kubo

ABSTRACT

PurposeNeurokinin-1 receptor antagonist (NK1RA) is recommended to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly or moderately emetogenic chemotherapy (HEC or MEC, respectively). We previously reported that aprepitant, an NK1RA, was needed to control CINV in 43% and 12% of patients who received HEC and MEC, respectively (Support Care Cancer 23:905–912, 2015). To elucidate the cost-effectiveness of aprepitant in these patients, a cost-utility analysis according to the necessity of aprepitant was performed.MethodsA decision-analytic model was developed according to the necessity of aprepitant and CINV responses in both acute and delayed phases of chemotherapy. Probabilities of health states and medical costs were derived from the results of the abovementioned trial.ResultIn patients who received HEC and needed aprepitant, the incremental cost-effectiveness ratio (ICER) with aprepitant, relative to the regimen with no aprepitant, was 7912 US dollars (USD) per quality-adjusted life year (QALY) gained, which was far below the commonly accepted threshold of 50,000 USD/QALY. The ICER was 27,457 USD/QALY in patients who received MEC and needed aprepitant. In contrast, in patients who received HEC or MEC but did not need aprepitant, the ICER was 175,959 or 478,844 USD/QALY, respectively.ConclusionRegardless of whether a patient received HEC or MEC, aprepitant use was highly cost-effective for patients who truly needed it. These results warrant further research to predict the necessity of NK1RA treatment before initiating emetogenic chemotherapies. More... »

PAGES

3749-3758

References to SciGraph publications

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  • 2008-03-10. A randomized study of aprepitant, ondansetron and dexamethasone for chemotherapy-induced nausea and vomiting in Chinese breast cancer patients receiving moderately emetogenic chemotherapy in BREAST CANCER RESEARCH AND TREATMENT
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    http://scigraph.springernature.com/pub.10.1007/s00520-019-04672-w

    DOI

    http://dx.doi.org/10.1007/s00520-019-04672-w

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    PUBMED

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    29 schema:description PurposeNeurokinin-1 receptor antagonist (NK1RA) is recommended to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly or moderately emetogenic chemotherapy (HEC or MEC, respectively). We previously reported that aprepitant, an NK1RA, was needed to control CINV in 43% and 12% of patients who received HEC and MEC, respectively (Support Care Cancer 23:905–912, 2015). To elucidate the cost-effectiveness of aprepitant in these patients, a cost-utility analysis according to the necessity of aprepitant was performed.MethodsA decision-analytic model was developed according to the necessity of aprepitant and CINV responses in both acute and delayed phases of chemotherapy. Probabilities of health states and medical costs were derived from the results of the abovementioned trial.ResultIn patients who received HEC and needed aprepitant, the incremental cost-effectiveness ratio (ICER) with aprepitant, relative to the regimen with no aprepitant, was 7912 US dollars (USD) per quality-adjusted life year (QALY) gained, which was far below the commonly accepted threshold of 50,000 USD/QALY. The ICER was 27,457 USD/QALY in patients who received MEC and needed aprepitant. In contrast, in patients who received HEC or MEC but did not need aprepitant, the ICER was 175,959 or 478,844 USD/QALY, respectively.ConclusionRegardless of whether a patient received HEC or MEC, aprepitant use was highly cost-effective for patients who truly needed it. These results warrant further research to predict the necessity of NK1RA treatment before initiating emetogenic chemotherapies.
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    37 CINV responses
    38 ConclusionRegardless
    39 HEC
    40 Japan
    41 MEC
    42 NK1RA
    43 NK1RA treatment
    44 PurposeNeurokinin-1 receptor antagonist
    45 ResultIn patients
    46 US dollars
    47 USD/quality-adjusted life year
    48 abovementioned trial
    49 analysis
    50 antagonist
    51 aprepitant
    52 aprepitant use
    53 chemotherapy
    54 chemotherapy-induced nausea
    55 contrast
    56 cost
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    58 cost-utility analysis
    59 decision analytic model
    60 delayed phases
    61 dollars
    62 emetogenic chemotherapy
    63 further research
    64 health states
    65 incremental cost-effectiveness ratio
    66 life years
    67 medical costs
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    69 nausea
    70 necessity
    71 necessity of aprepitant
    72 patients
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    77 receptor antagonist
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