HPE Managing CINV pocket guide 2019 | Page 49

alternatives examined? Yes Partial evaluation Cost-outcome description Cost-minimisation analysis Cost-effectiveness analysis Cost–utility analysis Cost–benefit analysis means that, in order to assess the costs of managing nausea and vomiting episodes induced by chemotherapy, not only the cost of the innovative pharmaceutical treatment but also any eventual savings due to its introduction (for example, reduced hospitalisations or increasing productivity at work) need to be included. Pharmacoeconomic evaluations comparing treatments of CINV can be performed in different settings (for example, inpatient or outpatient), involving different target patients and adopting mostly a societal, provider or payer perspective, although the societal one should always be preferred. A cost-effectiveness study of NEPA (oral fixed combination of netupitant 300mg and palonosetron 0.5mg) compared it with four currently recommended triple-agent antiemetics to prevent CINV in patients undergoing treatment with highly emetogenic chemotherapy in Germany and Greece. 15 Comparators were apreptitant (Apr) + ondansetron (Ond), Apr + palonosetron (Pal), fosaprepitant (Fos) + granisetron (Gra) and rolapitant (Rol) + Gra (only for Germany). A Markov model was developed to estimate the cost-effectiveness of NEPA on a five-day period, corresponding to the overall CINV phase, using the German health-care payer perspective. Direct healthcare costs considered were related to antiemetic drugs and management of episodes of CINV. Results showed that NEPA is a cost-effective strategy for prevention of CINV. Total cost of NEPA was €81.49 and it was the most effective with a total of 4.272 quality adjusted life days (QALDs; the primary outcome). The differential total costs were +€35.45, +€37.38, +€68.77 and +€6.89 for Apr+Ond, Apr+Pal, Fos+Gra and Rol+Gra, respectively. The total differential QALDs were -0.0004, -0.0001, -0.0004 and -0.0006, respectively. Proportions of CINV-free patients at five days (the secondary outcome) were 83.0% for NEPA and 79.4%, 83.0%, 79.1% and 75.5% for the comparators. NEPA was also dominant against all three comparators in Greece, hospitalpharmacyeurope.com | 2019 | 49