Implementation of institutional antiemetic guidelines for low emetic risk chemotherapy with docetaxel: a clinical and cost evaluation
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The purposes of this study were to evaluate the effect of implementation of institutional guidelines for low emetic risk chemotherapy with docetaxel and estimate the cost saving for all low emetic risk chemotherapies.
We examined the clinical effect of preparing and implementing institutional antiemetic guidelines for the breast cancer patients receiving adjuvant docetaxel therapy. Although the antiemetic medication for such patients used to be ondansetron 4 mg plus dexamethasone 8 mg (OND + DEX), it was changed to dexamethasone (DEX) 12 mg alone after implementation of the institutional guidelines. The effectiveness and adverse effects of DEX alone (56 patients, 205 courses) were compared with those of OND + DEX (41 patients, 151 courses). The cost saving was calculated from the antiemetic costs in both groups. The annual cost saving was estimated from the number of all low emetic risk chemotherapies in a year.
The incidences of nausea (19.5% versus 16.1%), vomiting (2.4% versus 0%), constipation (34.1% versus 30.4%), and insomnia (17.1% versus 17.9%) were not significantly different between the OND + DEX group and DEX alone group. In all low emetic risk chemotherapies, US $78,883 of potential cost saving was estimated in the first year after changing the antiemetic treatment.
The present results suggest that DEX alone is equally effective for preventing nausea and vomiting and less expensive compared with a 5-HT3 receptor antagonist plus DEX in low emetic risk chemotherapy with docetaxel.
KeywordsLow emetic risk chemotherapy Docetaxel Antiemetics Dexamethasone Cost-minimization analysis
- 13.National Comprehensive Cancer Network (NCCN) NCCN clinical practice guidelines in oncology. Antiemesis. V.2.2010. http://www.nccn.org/professionals/physician_gls/PDF/antiemesis.pdf. Accessed 17 June 2010
- 16.Italian Group for Antiemetic Research (2004) Cancer patients submitted to innovative chemotherapeutic agents of intermediate emetic potential: antiemetic prescriptions and incidence of emesis. Tumori 90:103–106Google Scholar
- 20.The Statistics Bureau, Ministry of Internal Affairs and Communications Basic Survey on Wage Structure 2008. http://www.e-stat.go.jp/SG1/estat/List.do?bid=000001022183&cycode=0. Accessed 17 June 2010 (in Japanese)
- 22.National Comprehensive Cancer Network (NCCN) (2010) NCCN clinical practice guidelines in oncology. Breast cancer. V.2.2010. http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf. Accessed 17 June 2010