Pharmacoeconomic analysis of ondansetron versus metoclopramide for cisplatin-induced nausea and vomiting

A pharmacoeconomic analysis of ondansetron versus metoclopramide use in patients receiving high-dose cisplatin therapy is reported. A meta-analysis of the literature was performed to synthesize the results of clinical trials of ondansetron and metoclopramide for the prevention of nausea and vomiting in patients receiving high-dose cisplatin therapy. A cost-benefit analysis was performed by constructing a decision tree of the possible outcomes of treatment with ondansetron or metoclopramide. Clinical outcomes were measured by counting the emesis episodes occurring within 24 hours after the antiemetic was given and the extrapyramidal reactions occurring after metoclopramide was given. The improvement in quality of life was transformed to an increase in quality-adjusted life years (QALYs) in order to conduct a cost-utility analysis. Only direct costs of drug, materials, and labor were included in the cost calculations. The meta-analysis, combined with empirical observations, yielded expected emesis rates of 2.03 and 2.69 per patient for ondansetron and metoclopramide, respectively. The rate of extrapyramidal symptoms for metoclopramide recipients was 6.8%. The cost-benefit analysis yielded estimated total costs of $139 ($211) and $116 ($154) per 40-kg (70-kg) patient receiving ondansetron and metoclopramide, respectively. The cost-utility analysis yielded an incremental cost of ondansetron of $168,391 ($407,667) per QALY in 40-kg (70-kg) patients. Sensitivity analysis showed robustness of the expected outcomes except in a best-case scenario. A cost-utility analysis suggested that, compared with metoclopramide, ondansetron provides a small antiemetic benefit at a large additional cost.