1
|
Inano H, Morimoto Y, Kitagawa K, Shibuya A, Nakagomi K, Ota T, Anzo Y, Miyauchi R, Shono A, Watanabe K, Otori K. Cost-effectiveness analysis of fosnetupitant in patients receiving cisplatin in Japan: analysis based on real-world data. Support Care Cancer 2025; 33:149. [PMID: 39904775 DOI: 10.1007/s00520-025-09210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 01/25/2025] [Indexed: 02/06/2025]
Abstract
PURPOSE Our previous study showed that the preventive effects of fosnetupitant (F-NTP) against chemotherapy-induced nausea and vomiting (CINV) were superior to those of fosaprepitant (F-APR) or aprepitant (APR). To evaluate the cost-effectiveness of F-NTP compared with F-APR or APR in Japan, a cost-utility analysis was performed. METHODS A decision tree model was developed based on real-world data to compare the CINV prevention ability of each neurokinin-1 receptor antagonist (NK1 RA) in Japanese patients receiving cisplatin-based regimens. We evaluated the patients 7 days after the first course of treatment. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated to examine the cost-effectiveness of the antiemetic therapy. The probabilities of health states and medical costs were derived from the results of our previous study. These cost-utility analyses were performed from the perspective of the payers. RESULTS The incremental QALYs of F-NTP relative to F-APR and APR were 0.00180 and 0.00153, respectively. The ICER of F-NTP relative to F-APR was 22,802.21 US dollars (USD) per QALY gained, which was lower than the willingness-to-pay (WTP) threshold (38,043.06 USD: 5 million Japanese Yen/QALY). Contrastingly, the ICER of F-NTP relative to APR was 40,119.64 USD/QALY, which was slightly above the WTP threshold, indicating that F-NTP may be slightly less cost-effective. CONCLUSION F-NTP is more cost-effective than F-APR, but slightly less cost-effective than APR.
Collapse
Affiliation(s)
- Hiroshi Inano
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Yoshihito Morimoto
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan.
| | - Kanata Kitagawa
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Akito Shibuya
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Kozue Nakagomi
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Tomohiro Ota
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Yuri Anzo
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Rika Miyauchi
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan
| | - Aiko Shono
- Laboratory of Public Health, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan
| | - Kazuhiro Watanabe
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan
| | - Katsuya Otori
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
- Laboratory of Pharmacy Practice and Science I, Research and Education Center for Clinical Pharmacy, School of Pharmacy, Kitasato University, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| |
Collapse
|
2
|
Suh D, Kim DW, Lee SM, Jung YS, Jung SY, Kim CM. Cost-effectiveness of prophylactic ramosetron in the prevention of postoperative nausea and vomiting. PLoS One 2024; 19:e0309592. [PMID: 39418317 PMCID: PMC11486367 DOI: 10.1371/journal.pone.0309592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/15/2024] [Indexed: 10/19/2024] Open
Abstract
OBJECTIVES This study was conducted to assess the cost-effectiveness of prophylactic use of ramosetron compared to no antiemetic medications for the prevention of postoperative nausea and vomiting (PONV) from the healthcare payer and societal perspectives in South Korea. METHOD A decision analytic model was constructed to assess the cost-effectiveness of prophylactic ramosetron use versus no antiemetic therapy at 24-hour and 48-hour periods post-surgery over a 5-day duration. The model was populated using costs and utility parameters from published studies as well as from surveys of an expert panel of physicians using structured questionnaires. The cost parameters included the costs of drugs, treatment, patient time, productivity loss, and transportation. Effectiveness was measured using quality adjusted life years (QALYs). The study outcome was the incremental cost-effectiveness ratio (ICER). The parameter uncertainties were addressed using deterministic and probabilistic scenario analyses. RESULTS The base-case analysis showed that, on average, patients treated with prophylactic ramosetron had lower costs from both the healthcare payer (US$16.88 vs US$17.33) and societal (US$16.89 vs US$18.72) perspectives and higher QALYs (0.0121 vs 0.0114) over the 5-day study duration compared to patients without any antiemetic medications. Deterministic and probabilistic sensitivity analyses were conducted to examine the robustness of results for the parameters included in the model. The acceptability curve probability showed that treating patients with ramosetron compared to no antiemetic medications was more than 99% cost-effective at a willingness-to pay threshold of US$5,000/QALY from both payer and societal perspectives. CONCLUSION The results demonstrated that prophylactic use of ramosetron compared to no antiemetic therapy is highly cost-effective to prevent PONV for patients undergoing surgery from both healthcare payer and societal perspectives. The cost effectiveness is the result of the decrease in the incidence of PONV and the direct treatment costs of severe PONV with improved patient quality of life.
Collapse
Affiliation(s)
- David Suh
- School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - Dong-Won Kim
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Seung-Mi Lee
- College of Pharmacy, Daegu Catholic University, Gyeongsan, Republic of Korea
| | - Yu-Seon Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Chul-Min Kim
- College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
3
|
Li Y, Yin H, Wu C, He J, Wang C, Ren B, Wang H, Geng D, Zhang Y, Zhao L. Preparation and in vivo evaluation of an intravenous emulsion loaded with an aprepitant-phospholipid complex. Drug Deliv 2023; 30:2183834. [PMID: 36843571 PMCID: PMC9979997 DOI: 10.1080/10717544.2023.2183834] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
In present, there was no detailed report on the formulation optimization and quality evaluation of aprepitant (APT) injectable lipid emulsion (APT-IE). The aim of the present investigation was to prepare and evaluate its properties of APT-IE loaded with an APT phospholipid complex (APT-PC) in vitro and in vivo. APT-PC was obtained by solvent evaporation with APT and phospholipids, then analyzed by X-ray diffraction, Fourier transform infrared spectroscopy and differential scanning calorimetry. Lipid emulsions are a new formulation that can reduce side effects and improve drug loading.APT-IE prepared by High-pressure homogenization and optimized by response surface methodology (RSM). The proportion of sodium oleate, poloxamer 188 and soybean oil were selected as variables for the optimization. The optimal formulation of ATP-IE had the following characteristics: particle size, 82.83 ± 1.89 nm; polydispersity index, 0.243 ± 0.008; zeta potential, -59.0 ± 2.54 mV; encapsulation efficiency, 98.84%±1.43%; drug loading, 7.08 ± 0.16 mg/mL; and osmotic pressure, 301 ± 2.15 mOsmol/kg. Transmission electron microscopy images indicated that the particle diameter of APT-IE was approximately 100 nm, with a morphology of spheroidal or spherical. APT-IE exhibited sufficient stability after storage at 4 ± 2 °C for more than 6 months. The results of the pharmacokinetic study demonstrated that APT-IE had the advantages of better safety, higher bioavailability, and obvious liver targeting than APT solution (APT-SL). The area under the curve (AUC) of APT-IE was 3-fold enhanced compared with APT-SL. The targeted enhancement multiple of APT-IE to liver tissue was greater than that of APT-SL. These results suggested that APT-IE has broad clinical application and industrial production potential.
Collapse
Affiliation(s)
- Yan Li
- Department of Pharmacy, Tangshan Maternal and Child Health Hospital, Tangshan, China
| | - Hong Yin
- School of Pharmacy, North China University of Science and Technology, Tangshan, China
| | - Chensi Wu
- School of Pharmacy, North China University of Science and Technology, Tangshan, China
| | - Jia He
- Department of Pharmacy, Hohhot Hospital of Traditional Chinese Medicine and Mongolian Medicine, Hohhot, China
| | - Chunyan Wang
- Department of Pharmacy, Tangshan Maternal and Child Health Hospital, Tangshan, China
| | - Bo Ren
- School of Pharmacy, North China University of Science and Technology, Tangshan, China
| | - Heping Wang
- School of Pharmacy, North China University of Science and Technology, Tangshan, China
| | - Dandan Geng
- School of Pharmacy, North China University of Science and Technology, Tangshan, China
| | - Yirong Zhang
- School of Pharmacy, North China University of Science and Technology, Tangshan, China
| | - Ligang Zhao
- School of Pharmacy, North China University of Science and Technology, Tangshan, China,Tangshan Key Lab of Novel Preparations and Drug Release Technology, Tangshan, China,CONTACT Ligang Zhao School of Pharmacy, North China University of Science and Technology, 21 Bohai Road of Caofeidian, Tangshan, Hebei063210, China
| |
Collapse
|
4
|
Kondo Y, Tachi T, Sakakibara T, Kato J, Kato A, Mizuno T, Miyake Y, Teramachi H. Cost-effectiveness analysis of pegfilgrastim in patients with non-small cell lung cancer receiving ramucirumab plus docetaxel in Japan. Support Care Cancer 2022; 30:6775-6783. [PMID: 35524869 DOI: 10.1007/s00520-022-07102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The dose-limiting factor of ramucirumab plus docetaxel (RAM + DTX) in patients with non-small cell lung cancer (NSCLC) is febrile neutropenia (FN), which has a high incidence in Asians. This study aimed to evaluate the cost-effectiveness of pegfilgrastim (Peg-G) in patients with NSCLC receiving RAM + DTX in Japan. METHODS We simulated model patients treated with RAM + DTX in Japan and developed a decision-analytical model for patients receiving Peg-G prophylaxis or no primary prophylaxis. The expected cost, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER) of each treatment were calculated from the perspective of a Japanese healthcare payer. The willingness-to-pay (WTP) threshold was set at 45,867 United States dollars (USD) (5 million Japanese yen) per QALY gained. The probabilities, utility values, and other costs were obtained from published sources. Deterministic sensitivity analysis (DSA) and probabilistic analysis were conducted to evaluate the effect of each parameter and robustness of the base-case results. RESULTS The expected cost and QALYs were 20,275 USD and 0.701 for Peg-G prophylaxis and 17,493 USD and 0.672 for no primary prophylaxis, respectively. The ICER was calculated to be 97,519 USD per QALY gained. The results were most sensitive to FN risk with Peg-G. When FN risk with no primary prophylaxis exceeded 51% or the cost of Peg-G was less than 649 USD per injection, the ICER was below the WTP threshold. The probabilistic analysis revealed a 9.1% probability that the ICER was below the WTP threshold. CONCLUSION Peg-G is not cost-effective in patients with NSCLC receiving RAM + DTX in Japan.
Collapse
Affiliation(s)
- Yu Kondo
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan.
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan.
| | - Tomoya Tachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan
| | - Takayoshi Sakakibara
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Jun Kato
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Aki Kato
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Takahito Mizuno
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Yoshio Miyake
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Hitomi Teramachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan.
| |
Collapse
|
5
|
Kondo Y, Tachi T, Sakakibara T, Kato J, Mizuno T, Miyake Y, Teramachi H. Cost-effectiveness analysis of olanzapine in four-drug antiemetic therapy in Japanese patients treated with highly emetogenic cisplatin-containing chemotherapy. J Pharm Health Care Sci 2022; 8:15. [PMID: 35642015 PMCID: PMC9158179 DOI: 10.1186/s40780-022-00246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Olanzapine has been shown to have an additive effect on the three-drug antiemetic therapy consisting of aprepitant, palonosetron, and dexamethasone, in a highly emetogenic cisplatin-containing chemotherapy. Although olanzapine may be more economical than aprepitant or palonosetron, an adequate cost-efficacy analysis has not been conducted. Methods We conducted a cost-utility analysis to evaluate the cost-effectiveness of olanzapine use in four-drug antiemetic therapy among Japanese patients. We simulated model patients treated with highly emetogenic cisplatin-containing chemotherapy and developed a decision-analytical model of patients receiving triple antiemetic therapy with or without olanzapine in an inpatient setting. The cost and probabilities of each treatment were calculated from the perspective of the Japanese healthcare payer. The probabilities, utility value, and other costs were obtained from published sources. One-way and probabilistic sensitivity analyses were conducted to examine the influence of each parameter on the model and the robustness of a base-case analysis. Threshold analysis was conducted to determine the cost of olanzapine that would make the incremental cost-effectiveness ratio (ICER) equivalent to the threshold ICER). The threshold incremental cost-effectiveness ratio was set at 5 million Japanese Yen (JPY) per quality-adjusted life-year (QALY) gained. Results The cost was 10,238 JPY in the olanzapine regimen and 9719 JPY in the non-olanzapine regimen. The QALY gained were 0.01065 QALYs and 0.01029 QALYs in the olanzapine and non-olanzapine regimen, respectively. The incremental cost of the olanzapine regimen relative to the non-olanzapine regimen was 519 JPY, and the incremental QALYs were 0.00036 QALY, resulting in an ICER of 1,428,675 JPY per QALY gained. In the one-way sensitivity analysis, the results were most sensitive to the utility value of incomplete control. The probabilistic sensitivity analysis revealed the probability that the ICER was below the willingness-to-pay, and the incremental QALYs was positive was 96.2%. The calculated cost of olanzapine per 5 mg that would make the incremental cost-effectiveness ratio equivalent to the threshold incremental cost-effectiveness ratio was calculated to be 475 JPY. Conclusions Olanzapine was cost-effective in the four-drug antiemetic therapy for Japanese patients treated with highly emetogenic cisplatin-containing chemotherapy.
Collapse
Affiliation(s)
- Yu Kondo
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan. .,Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan.
| | - Tomoya Tachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan
| | - Takayoshi Sakakibara
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Jun Kato
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Takahito Mizuno
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Yoshio Miyake
- Department of Pharmacy, Toyota Kosei Hospital, 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Hitomi Teramachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Daigaku-nishi 1-25-4, Gifu, 501-1196, Japan.
| |
Collapse
|
6
|
Li Y, Sun Y, Liu B, Sun Y, Chen P, Xie K, Wang Y, Zhu J. Prolonged administration of aprepitant improves cisplatin-based chemotherapy-induced nausea and vomiting. Future Oncol 2022; 18:2533-2543. [PMID: 35587019 DOI: 10.2217/fon-2021-1523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aims: To determine the antiemetic efficacy of a 6-day aprepitant schedule in patients receiving multiple-day cisplatin. Patients & methods: Patients diagnosed with lung cancer and who were chemotherapy naive were screened. The patients willing to use aprepitant were randomly divided into two groups: prolonged use of aprepitant (PA; 6-day aprepitant) and standard use of aprepitant (SA; 3-day aprepitant); the patients who rejected aprepitant were recruited into the control group (group C). Primary end points included the safety and the number of days without chemotherapy-induced nausea and vomiting. Results: There was no statistical difference in adverse events among the three groups. The average days without chemotherapy-induced nausea and vomiting of group PA (18.28 ± 3.35) was significantly longer than in groups SA and C. Furthermore, better life function scores were achieved in group PA according to the Functional Living Index - Emesis questionnaire. Conclusion: In this study 6-day aprepitant was safe and more effective than standard 3-day aprepitant in controlling chemotherapy-induced nausea and vomiting due to 3-day cisplatin regimens.
Collapse
Affiliation(s)
- Yanying Li
- Department of Thoracic Oncology, West China Hospital of Sichuan University, Chengdu, China
| | - Yu Sun
- Department of Radiotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Thoracic Oncology, Sichuan Provincial Cancer Hospital, Chengdu, China
| | - Yi Sun
- Department of Oncology & Hematology, The 452nd Hospital of PLA, Chengdu, China
| | - Ping Chen
- The Center of Lung Cancer, No.7 People's Hospital of Chengdu, Chengdu, China
| | - Ke Xie
- Department of Oncology, The People's Hospital of Sichuan Province, Chengdu, China
| | - Yan Wang
- Department of IVF, West China Second Hospital of Sichuan University, Chengdu, China
| | - Jiang Zhu
- Department of Thoracic Oncology, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Qiu T, Men P, Sun T, Zhai S. Cost-Effectiveness of Aprepitant in Preventing Chemotherapy-Induced Nausea and Vomiting: A Systematic Review of Published Articles. Front Public Health 2021; 9:660514. [PMID: 34513778 PMCID: PMC8424090 DOI: 10.3389/fpubh.2021.660514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives: The aim of this systematic review is to assess the published cost-effectiveness analyses of aprepitant for patients with chemotherapy-induced nausea and vomiting (CINV). Methods: A systematic literature search was performed on PubMed, EMbase, the Cochrane Library, CNKI, WANFANG DATA, and CBM database. The date of publication is up to January 2019. Two reviewers independently reviewed titles, abstracts, and articles sequentially to select studies for data abstraction based on the inclusion and exclusion criteria. Disagreements were resolved and reviewers reached a consensus. The quality of the included studies was assessed according to the 24-item checklist of the consolidated health economic evaluation reporting standards (CHEERS). The costs reported by the included studies were converted to US dollars via purchasing power parities (PPP) in the year 2019 using the CCEMG–EPPI–Certer Cost Converter. Results: Thirteen articles were included based on the inclusion criteria for cost-effectiveness analysis and cost-utility analysis. Twelve studies were rated as good quality and one as a moderate quality based on the CHEERS checklist. Eight studies compared aprepitant plus 5-hydroxytryptamine-3 receptor antagonist (5-HT3RA) and dexamethasone with the standard regimen (5-HT3RA and dexamethasone). It was concluded that aprepitant plus standard regimen was a cost-effective strategy for preventing CINV. Only one study that compared aprepitant plus 5-HT3RA with 5-HT3RA, concluded that the addition of aprepitant reduced the incidence of severe nausea, and it might also provide an economic benefit in the overall management. Four studies that compared aprepitant with other antiemetic drugs concluded that aprepitant is a cost-effective strategy for preventing CINV compared with metoclopramide. However, netupitan + palonosetron and olanzapine are cost-effective compared with aprepitant. Conclusion: This study is the first systematic evaluation of adding aprepitant to standard regimens for patients with CINV. Most economic evaluations of antiemetic medications are reported to be of good quality. Adding aprepitant to standard regimens is found to be a cost-effective strategy for preventing CINV.
Collapse
Affiliation(s)
- Tingting Qiu
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Peng Men
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Tong Sun
- Department of Pharmacy, Aviation General Hospital, Beijing, China
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China.,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| |
Collapse
|
8
|
Watanabe Y, Saito Y, Mitamura T, Takekuma Y, Sugawara M. Adding aprepitant to palonosetron does not decrease carboplatin-induced nausea and vomiting in patients with gynecologic cancer. J Pharm Health Care Sci 2021; 7:21. [PMID: 34059157 PMCID: PMC8168009 DOI: 10.1186/s40780-021-00204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, aprepitant has been recommended in carboplatin-based regimens, but there are limited reports on the efficacy of administering aprepitant, palonosetron, and dexamethasone (DEX) in carboplatin-containing regimens. Moreover, because aprepitant is an expensive drug, confirming its effectiveness is very important from the medical cost perspective. In this study, we examined the efficacy of prophylactically administered aprepitant, palonosetron and DEX, in paclitaxel and carboplatin (TC) combination chemotherapy. METHODS Patients with gynecologic cancer who were treated with paclitaxel (175 mg/m2) and carboplatin (area under the curve, AUC = 5-6) combination chemotherapy were retrospectively evaluated. The complete response (CR) rate, severity of nausea, and incidence of anorexia in the first course were compared between patients who did not receive aprepitant (control group) and those who received (aprepitant group). RESULTS The 106 patients were divided into two groups, consisting of 52 and 54 the control and aprepitant groups, respectively, and the patient background showed no significant difference between both groups. The CR rate of the overall phase between the control and aprepitant groups was 73.1 vs. 74.1%, that in the acute phase was 98.1 vs. 100%, and in the delayed phase was 75.0 vs. 74.1%, respectively, without any significant difference. The severity of nausea and incidence of anorexia were also not significantly different between both groups. CONCLUSIONS The results of the study suggest that adding aprepitant to palonosetron and DEX does not prevent carboplatin-induced nausea and vomiting in gynecologic cancer patients. Therefore, adding aprepitant to palonosetron does not decrease carboplatin-induced nausea and vomiting in patients with gynecologic cancer.
Collapse
Affiliation(s)
- Yuko Watanabe
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Yoshitaka Saito
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Takashi Mitamura
- Department of Obstetrics and Gynecology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15-jo, Nishi 7-chome, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan.
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo, 060-0812, Japan.
| |
Collapse
|
9
|
Meng Q, Cheng Q, Feng X, Chen S, Li Y, Zhang G, Nie K. The Antiemetic Effect of Xiao-Ban-Xia-Tang Formula against Cisplatin-Induced Emesis is Mediated through Inhibition of NLRP3 Inflammasome Activation in a Rat Pica Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:5497078. [PMID: 32308708 PMCID: PMC7146096 DOI: 10.1155/2020/5497078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/07/2020] [Indexed: 11/19/2022]
Abstract
Xiao-Ban-Xia-Tang (XBXT), a traditional Chinese medicine formula, has been used for the treatment of emesis for nearly 2000 years, but its underlying mechanism is not yet fully clarified. The purpose of this study is to reveal the antiemetic mechanisms of XBXT by focusing on the NLRP3 inflammasome pathway in a chemotherapy-induced rat pica model. The pica model was generated by a single intraperitoneal injection of cisplatin in this study. Consumption of kaolin (a type of clay) and food and body weight were recorded every 24 hours. Cisplatin-induced increase in kaolin consumption (pica) was used to quantify chemotherapy-induced nausea and vomiting (CINV). Tissue from the ileum and antrum was stained with hematoxylin eosin (HE) to observe pathological changes. The levels of reactive oxygen species (ROS) and inflammatory cytokines, including IL-1β and IL-18 in serum, were detected by ELISA. In addition, changes in the NLRP3 inflammasome activation in the ileum and antrum were investigated using western blot and immunofluorescence microscopy. The results showed that oral administration of XBXT and ondansetron inhibited acute and delayed pica and significantly protected against the gastrointestinal pathological injury induced by cisplatin. The levels of ROS, IL-1β, and IL-18 in the serum of cisplatin-treated rats were also remarkably decreased by XBXT and ondansetron. Moreover, we found that XBXT can inhibit cisplatin-induced NLRP3 inflammasome activation. The present study indicates that the inhibition of the NLRP3 inflammasome activation might be one of the potential mechanisms for the therapeutic effects of XBXT against CINV.
Collapse
Affiliation(s)
- Qi Meng
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - QianQian Cheng
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Xiaodi Feng
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Siqi Chen
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Yaqi Li
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Guanglong Zhang
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Ke Nie
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou 510006, China
| |
Collapse
|
10
|
Kashiwa M, Matsushita R. Cost-utility analysis of palonosetron in the antiemetic regimen for cisplatin-containing highly emetogenic chemotherapy in Japan. BMC Health Serv Res 2019; 19:438. [PMID: 31262292 PMCID: PMC6604132 DOI: 10.1186/s12913-019-4281-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/19/2019] [Indexed: 02/08/2023] Open
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.
Collapse
Affiliation(s)
- Munenobu Kashiwa
- Division of Pharmacy, Graduate School of Medical Sciences, Kanazawa University, Kakuma-machi, Kanazawa, 920-1192, Japan. .,Department of Pharmacy, First Towakai Hospital, Takatsuki, Japan.
| | - Ryo Matsushita
- Division of Pharmaceutical Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
11
|
Kashiwa M, Matsushita R. Comparative Cost-utility Analysis Between Aprepitant- and Fosaprepitant-containing Regimens To Prevent Chemotherapy-induced Nausea and Vomiting in Patients Receiving Highly Emetogenic Chemotherapy in Japan. Clin Ther 2019; 41:929-942. [PMID: 31036286 DOI: 10.1016/j.clinthera.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/29/2019] [Accepted: 03/17/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Clinical trials have shown that the addition of aprepitant (APR) or a phosphorylated prodrug of aprepitant, fosaprepitant (FosAPR) as prophylactic antiemetic therapy consisting of a 5-hydrotryptamine-3 receptor antagonist and dexamethasone is effective in patients receiving highly emetogenic chemotherapy. These combination therapies have been commonly used in Japan. In the present study, we performed a cost-utility analysis of APR and FosAPR in the context of the Japanese medical insurance system, and economic efficiency was compared. METHODS Data from randomized controlled trials that examined the efficacy of APR and FosAPR in the Japanese population were used. A decision tree was constructed to estimate the effectiveness of chemotherapy for 5 days from the day of the treatment and the cost associated with outpatient chemotherapy from the perspective of a payer. Health outcome was expressed in quality-adjusted life-years (QALYs), and costs were estimated based on medical fees and drug prices from 2018. An incremental cost-effectiveness ratio (ICER) was calculated for each regimen containing either APR or FosAPR. The robustness of the model was assessed using 1-way and probabilistic sensitivity analysis. FINDINGS The base-case analysis estimated that the addition of APR or FosAPR would have incremental effects of 0.00166 and 0.00143 QALY and incremental costs of 8305 and 11,348 JPY (74 and 101 USD [1 USD = 112.17 JPY]), resulting in ICERs of 4,992,172 and 7,955,560 JPY/QALY (44,505 and 70,924 USD/QALY), respectively. Sensitivity analysis revealed that the probability of a complete response for delayed chemotherapy-induced nausea and vomiting had the most influence on the ICERs. Reductions in the drug costs of APR and FosAPR also had an effect on the ICERs. According to the probabilistic sensitivity analysis, APR and FosAPR were dominant in terms of cost-effectiveness in 48.7% and 8.55% of cases, respectively. IMPLICATIONS The ICER of outpatient prophylactic antiemetic therapy in patients receiving highly emetogenic chemotherapy was calculated in the context of the Japanese medical insurance system. Assuming the willingness-to-pay of 5,000,000 JPY/QALY based on the calculated ICER, our findings suggest that although the addition of APR is cost-effective, FosAPR is not cost-effective.
Collapse
Affiliation(s)
- Munenobu Kashiwa
- Division of Pharmacy, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan; Department of Pharmacy, First Towakai Hospital, Takatsuki, Japan
| | - Ryo Matsushita
- Division of Pharmaceutical Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
| |
Collapse
|
12
|
Tsukiyama I, Ando M, Tsukiyama S, Takeuchi M, Ejiri M, Kurose Y, Saito H, Arakawa I, Inoue T, Yamaguchi E, Kubo A. Cost-utility analysis of aprepitant for patients who truly need it in Japan. Support Care Cancer 2019; 27:3749-3758. [PMID: 30710243 DOI: 10.1007/s00520-019-04672-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/21/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Neurokinin-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. METHODS A 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. RESULT In 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. CONCLUSION Regardless 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.
Collapse
Affiliation(s)
- Ikuto Tsukiyama
- Faculty of Pharmacy, Meijo University, Nagoya, Japan
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Masahiko Ando
- Center for Advanced Medical and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Sumiyo Tsukiyama
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Masayuki Takeuchi
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Masayuki Ejiri
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Yusuke Kurose
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Hiroko Saito
- Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan
| | - Ichiro Arakawa
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan
| | - Tadao Inoue
- School of Pharmaceutical Sciences, Ohu University, Koriyama, Japan
| | - Etsuro Yamaguchi
- Division of Respiratory Medicine and Allergology, School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Akihito Kubo
- Division of Respiratory Medicine and Allergology, School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| |
Collapse
|
13
|
Tsukiyama I, Hasegawa S, Ikeda Y, Takeuchi M, Tsukiyama S, Kurose Y, Ejiri M, Sakuma M, Saito H, Arakawa I, Inoue T, Yamaguchi E, Kubo A. Cost-effectiveness of aprepitant in Japanese patients treated with cisplatin-containing highly emetogenic chemotherapy. Cancer Sci 2018; 109:2881-2888. [PMID: 29999572 PMCID: PMC6125450 DOI: 10.1111/cas.13736] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/07/2018] [Indexed: 11/30/2022] Open
Abstract
Chemotherapy‐induced nausea and vomiting (CINV) remains a major adverse event in cancer chemotherapy. Although aprepitant is effective in preventing CINV, an increment in financial burden for uniform use of aprepitant is a concern. The aim of the present study was to define the cost‐effectiveness of aprepitant from the perspective of the Japanese National Health Insurance system. Based on the results of a randomized phase II trial comparing an aprepitant‐containing regimen versus a nonaprepitant regimen in Japanese patients who received cisplatin‐containing highly emetogenic chemotherapy, a decision analytic model was developed. The incremental cost‐effectiveness ratio (ICER) was calculated both in the outpatient care setting (OCS) and in the inpatient care setting (ICS). The use of the aprepitant‐containing regimen was associated with improved quality of life compared with the nonaprepitant regimen, with an increment in quality‐adjusted life years (QALY) of 0.0016. The incremental total medical costs associated with the use of the aprepitant regimen were lower in the OCS than in the ICS, 6192 JPY (56.92 USD) and 9820 JPY (90.27 USD), respectively. The ICER was calculated as 3 906 698 JPY (35 910 USD) per QALY gained in the OCS and 6 195 781 JPY (56 952 USD) per QALY gained in the ICS. Cost‐effectiveness of the aprepitant‐containing antiemetic therapy was limited to the OCS, considering the threshold of willingness‐to‐pay commonly accepted (5 million JPY [45 960 USD] in Japan and 50 000 USD in the USA). The efficacy of aprepitant offsets the costs for revisiting clinics or rehospitalization added with rescue medications in the OCS.
Collapse
Affiliation(s)
- Ikuto Tsukiyama
- Faculty of Pharmacy, Meijo University, Nagoya, Japan.,Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | | | - Yoshiaki Ikeda
- School of Pharmacy, Kinjo Gakuin University, Nagoya, Japan
| | - Masayuki Takeuchi
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Sumiyo Tsukiyama
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yusuke Kurose
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masayuki Ejiri
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Masaki Sakuma
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiroko Saito
- Department of Pharmacy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Ichiro Arakawa
- Faculty of Pharmacy, Teikyo Heisei University, Chiba, Japan
| | - Tadao Inoue
- Faculty of Pharmacy, Ohu University, Koriyama, Japan
| | - Etsuro Yamaguchi
- Department of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Akihito Kubo
- Department of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine, Nagakute, Japan
| |
Collapse
|