Semester

Fall

Date of Graduation

2005

Document Type

Dissertation

Degree Type

PhD

College

School of Pharmacy

Department

Pharmaceutical Sciences

Committee Chair

Lesley-Ann Miller.

Abstract

New antiemetic agents, aprepitant and palonosetron have been approved for prevention of chemotherapy-induced nausea and vomiting (CINV). The objectives of the two phases of the study were: (1) to conduct cost-effectiveness analysis of antiemetic regimens for prevention of CINV in patients receiving highly emetogenic chemotherapy (HEC) and in patients receiving moderately emetogenic chemotherapy (MEC) using decision models, and (2) to determine the monetary value of improved emesis control and conduct cost-benefit analysis of the new antiemetic regimens. Regimen A, one of the four antiemetic strategies included in the HEC decision model was a combination of aprepitant and the standard regimen of ondansetron+dexamethasone. The other three regimens had standard regimen in the acute phase but differed in the delayed phase regimens: regimen B - dexamethasone only, regimen C - dexamethasone+metoclopramide and regimen D - dexamethasone+ondansetron. The four antiemetic strategies for prevention of CINV due to MEC were: regimen (1) IV palonosetron, (2) IV ondansetron, (3) ondansetron+dexamethasone in acute phase, only dexamethasone in delayed phase, (4) ondansetron+dexamethasone in acute and delayed phase. The outcome measure was the incremental cost-effectiveness ratios (ICER) measured as cost/patient with complete control of emesis. For the HEC model, the ICER of regimen A compared to C was {dollar}3,363.18 and {dollar}2,881.61 per patient with complete control of emesis, from payer and societal perspectives respectively. One-way and probabilistic sensitivity analyses indicated that the conclusions were relatively stable to variations in multiple parameters. For MEC model, regimen 1 was found to be most cost-effective with ICER of {dollar}3,582.48 and {dollar}3,549.02, from payer and societal perspectives respectively. Overall, the ICER results showed that the regimen A and regimen 1 could be considered cost-effective therapies for prevention of CINV. In phase II, a contingent valuation survey was developed and administered to 120 cancer patients who were either receiving or had received chemotherapy. The results showed that respondents were willing-to-pay on average {dollar}83.50 for a single dose of palonosetron and {dollar}89.90 for a three-day regimen of aprepitant. Phase II qualitative results also emphasized that cancer patients receiving chemotherapy placed a high importance on receiving even a modest improvement in the control of CINV.

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