Changes in Antiemetic Overuse in Response to Choosing Wisely Recommendations

Area of Science:

• Oncology
• Health Economics
• Clinical Pharmacy

Background:

• Antiemetics are crucial for managing chemotherapy-induced nausea and vomiting (CINV).
• Newer antiemetics offer higher efficacy but at a significant cost.
• The Choosing Wisely (CW) campaign aimed to reduce overuse of expensive antiemetics in low-risk patients.

Purpose of the Study:

• To determine the prevalence, trends, and costs of antiemetic overuse.
• To assess the impact of the 2013 Choosing Wisely guidelines on antiemetic overuse patterns.

Main Methods:

• Observational study using nationwide insurance claims data (2008-2015).
• Analysis of 678,220 privately insured patients receiving chemotherapy.
• Descriptive and regression analyses to evaluate overuse before and after CW guidelines.

Main Results:

• Antiemetic overuse affected 24.1% of patients, particularly those receiving high-risk intravenous chemotherapy.
• A temporary 7.0% decrease in overuse followed the CW guidelines, but this reversed within 6 months.
• Overuse was linked to increased healthcare costs, with potential savings of 6.1% of chemotherapy drug costs.

Conclusions:

• Antiemetic overuse is a prevalent issue leading to substantial unnecessary healthcare expenditure.
• The Choosing Wisely recommendation had a short-lived impact on reducing overuse, with sustained reductions seen only in specific patient groups.
• Strategies for sustained reduction of antiemetic overuse are needed to optimize cancer care costs.