Comparative Cost-Utility and Clinical Efficacy of 5-HT3 Receptor Antagonists in Sufentanil-Based PCIA: A Propensity...

Postoperative pain management using sufentanil-based patient-controlled intravenous analgesia (PCIA) is often compromised by opioid-induced nausea and vomiting. Although 5-HT3 receptor antagonists are commonly added to PCIA regimens, the effectiveness of continuous of low-concentration infusion strategies remains uncertain from a pharmacokinetic perspective. Furthermore, China's national volume-based procurement (VBP) policy has drastically altered the cost landscape, necessitating a re-evaluation of premium agents such as palonosetron. This study aimed to assess the incremental clinical outcomes and cost-effectiveness of palonosetron versus ondansetron in this specific post-VBP setting.

We conducted a retrospective cohort study with propensity score matching (PSM). Patients receiving sufentanil-based PCIA were grouped as sufentanil alone, sufentanil plus ondansetron, or sufentanil plus palonosetron. The primary outcomes were the incidence of postoperative nausea and vomiting (PONV). A cost-effectiveness analysis (CEA) was performed using bootstrapping and cost-effectiveness acceptability curves (CEAC).

After matching, neither palonosetron nor ondansetron significantly reduced overall PONV incidence compared with sufentanil alone. However, subgroup analyses revealed that palonosetron significantly reduced severe nausea in elderly patients (P < 0.05). From an economic perspective, palonosetron demonstrated a high probability (87.0%) of being cost-saving in a probabilistic sensitivity analysis, whereas ondansetron was likely to be "dominated."

Under low-concentration background infusion regimens, 5-HT3 antagonists may provide limited benefit in the general patient population, especially high-risk female patients. However, in the context of VBP-driven price reductions, palonosetron may represent a cost-saving option, with potential benefits in elderly patients, and may confer additional prophylactic advantages in male patients.