Supportive Care in Cancer

, Volume 27, Issue 3, pp 1109–1119 | Cite as

Cost-effectiveness analysis of olanzapine-containing antiemetic therapy for managing highly emetogenic chemotherapy in Southeast Asia: a multinational study

  • Suthan Chanthawong
  • Yi Heng Lim
  • Suphat Subongkot
  • Alexandre Chan
  • Rizka Andalusia
  • Ros Suzanna Ahmad Bustamam
  • Nathorn ChaiyakunaprukEmail author
Original Article



Recent studies suggested that olanzapine, together with dexamethasone and serotonin-3 receptor antagonist (5HT3RA), is effective in preventing chemotherapy-induced nausea and vomiting (CINV) following highly emetogenic chemotherapy (HEC). This regimen is particularly useful in Southeast Asia (SEA) countries where resources are limited. We aimed to evaluate the cost-effectiveness of incorporating olanzapine into standard antiemetic regimens for the prevention of CINV in patients receiving HEC among SEA countries.


Using a decision tree model, clinical and economic outcomes associated with olanzapine-containing regimen and standard antiemetic regimen (doublet antiemetic regimen: dexamethasone+first generation 5HT3RA) in most SEA countries except in Singapore (triplet antiemetic regimen: dexamethasone+first generation 5HT3RA + aprepitant) for CINV prevention following HEC were evaluated. This analysis was performed in Thailand, Malaysia, Indonesia, and Singapore, using societal perspective method with 5-day time horizon. Input parameters were derived from literature, network meta-analysis, government documents, and hospital databases. Outcomes were incremental cost-effectiveness ratio (ICER) in USD/quality-adjusted life year (QALY) gained. A series of sensitivity analyses including probabilistic sensitivity analysis were also performed.


Compared to doublet antiemetic regimen, addition of olanzapine resulted in incremental QALY of 0.0022–0.0026 with cost saving of USD 2.98, USD 27.71, and USD 52.20 in Thailand, Malaysia, and Indonesia, respectively. Compared to triplet antiemetic regimen, switching aprepitant to olanzapine yields additional 0.0005 QALY with cost saving of USD 60.91 in Singapore. The probability of being cost-effective at a cost-effectiveness threshold of 1 GDP/capita varies from 14.7 to 85.2% across countries.


The use of olanzapine as part of standard antiemetic regimen is cost-effective for the prevention of CINV in patients receiving HEC in multiple SEA countries.


Olanzapine Cost-effectiveness analysis Chemotherapy-induced nausea and vomiting CINV 



The authors are grateful for Dr.Kednapa Thavorn for her valuable advice and guidance on the research design and implementation of input parameters.


All authors were involved in aspects of study design, data collection, and/or analysis of data used in the report. SC, YL, SS, and NC wrote the first draft of the report. All authors contributed to subsequent drafts of the report and reviewed the final version before submission.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

520_2018_4400_MOESM1_ESM.docx (12.9 mb)
ESM 1 (DOCX 12.9 MB)


  1. 1.
    de Boer-Dennert M, de Wit R, Schmitz PI, Djontono J, v Beurden V, Stoter G, Verweij J (1997) Patient perceptions of the side-effects of chemotherapy: the influence of 5HT3 antagonists. Br J Cancer 76:1055–1061CrossRefGoogle Scholar
  2. 2.
    Sun CC, Bodurka DC, Donato ML, Rubenstein EB, Borden CL, Basen-Engquist K, Munsell MF, Kavanagh JJ, Gershenson DM (2002) Patient preferences regarding side effects of chemotherapy for ovarian cancer: do they change over time? Gynecol Oncol 87:118–128CrossRefGoogle Scholar
  3. 3.
    Schwartzberg L, Harrow B, Lal LS, Radtchenko J, Lyman GH (2015) Resource utilization for chemotherapy-induced nausea and vomiting events in patients with solid tumors treated with antiemetic regimens. Am Health Drug Benefits 8:273–282Google Scholar
  4. 4.
    Hesketh PJ, Grunberg SM, Gralla RJ, Warr DG, Roila F, de Wit R, Chawla SP, Carides AD, Ianus J, Elmer ME, Evans JK, Beck K, Reines S, Horgan KJ (2003) The oral neurokinin-1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a multinational, randomized, double-blind, placebo-controlled trial in patients receiving high-dose cisplatin—the Aprepitant Protocol 052 Study Group. J Clin Oncol 21:4112–4119Google Scholar
  5. 5.
    Poli-Bigelli S, Rodrigues-Pereira J, Carides AD, Julie Ma G, Eldridge K, Hipple A, Evans JK, Horgan KJ, Lawson F, On behalf of the Aprepitant Protocol 054 Study Group (2003) Addition of the neurokinin 1 receptor antagonist aprepitant to standard antiemetic therapy improves control of chemotherapy-induced nausea and vomiting. Results from a randomized, double-blind, placebo-controlled trial in Latin America. Cancer 97:3090–3098CrossRefGoogle Scholar
  6. 6.
    Chiu L, Chow R, Popovic M, Navari RM, Shumway NM, Chiu N, Lam H, Milakovic M, Pasetka M, Vuong S, Chow E, DeAngelis C (2016) Efficacy of olanzapine for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV): a systematic review and meta-analysis. Support Care Cancer 24:2381–2392. CrossRefGoogle Scholar
  7. 7.
    Wang XF, Feng Y, Chen Y, Gao BL, Han BH (2014) A meta-analysis of olanzapine for the prevention of chemotherapy-induced nausea and vomiting. Sci Rep 4:4813. CrossRefGoogle Scholar
  8. 8.
    Wang SY, Yang ZJ, Zhang L (2014) Olanzapine for preventing nausea and vomiting induced by moderately and highly emetogenic chemotherapy. Asian Pac J Cancer Prev 15:9587–9592CrossRefGoogle Scholar
  9. 9.
    Johannesson M (1997) Avoiding double-counting in pharmacoeconomic studies. Pharmacoeconomics 11:385–388CrossRefGoogle Scholar
  10. 10.
    Wisit K, Tanyasaensook K, Thavorncharoensap M, Maneechavakajorn J, Chiaovit J (2013) Anti-emetic prophylaxis medication pattern for chemotherapy induced nausea vomiting (CINV) in patients with solid tumor at Rajavithi Hospital. Proceedings of The 2nd ASEAN Plus Three Graduate Research Congress Bangkok, Thailand 5-7 February 2014Google Scholar
  11. 11.
    Konmun J, Danwilai K, Ngamphaiboon N, Sripanidkulchai B, Sookprasert A, Subongkot S (2014) A phase II randomized, double-blind placebo-controlled trial of an antiemetic, 6-gingerol in solid tumor patients receiving moderately to highly emetogenic adjuvant chemotherapy. J Clin Oncol 32:9647Google Scholar
  12. 12.
    Hassan BA, Yusoff ZB (2010) Negative impact of chemotherapy on breast cancer patients QOL—utility of antiemetic treatment guidelines and the role of race. Asian Pac J Cancer Prev 11:1523–1527Google Scholar
  13. 13.
    Chan A, Low XH, Yap KY (2012) Assessment of the relationship between adherence with antiemetic drug therapy and control of nausea and vomiting in breast cancer patients receiving anthracycline-based chemotherapy. J Manag Care Pharm 18:385–394Google Scholar
  14. 14.
    Drug and Medical Supplies Information Center (DMSIC) Ministry of Public Health: unit prices of pharmaceutical products, Ministry of Public Health, 2015Google Scholar
  15. 15.
    Health Intervention and Technology Assessment: HITAP Ministry of Public Health: standard cost list for health technology assessment, 2010Google Scholar
  16. 16.
    Elamin EI, Ibrahim MI, Sulaiman SA, Muttalif AR (2008) Cost of illness of tuberculosis in Penang, Malaysia. Pharm World Sci 30:281–286.
  17. 17.
    Ministry of Health (2011) National Health and Morbidity Survey 2011Google Scholar
  18. 18.
    Lopes G, Burke T, Pellissier J, Zhang XH, Dedhiya S, Chan A (2012) Aprepitant for patients receiving highly emetogenic chemotherapy: an economic analysis for Singapore. Value in Health Regional 1:66–74CrossRefGoogle Scholar
  19. 19.
    Ministry of Commerce Thailand: Consumer Price Index (CPI), 2016Google Scholar
  20. 20.
    Bank Indonesia: Indonesia financial statistics: VIII. 1. Composite Consumer Price Index of 82 cities (2012=100). 2017Google Scholar
  21. 21.
    Department of Statistics Malaysia: Consumer Price Index Malaysia December 2016, 2017Google Scholar
  22. 22.
    Department of Statistics Singapore: Consumer Price Index (CPI), base year 2014 = 100, Annual, 2017Google Scholar
  23. 23.
    Ettinger DS, Berger MJ, Aston J et al (2016) NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Antiemesis Version 2.2016Google Scholar
  24. 24.
    Chanthawong S, Subongkot S, Sookprasert A (2014) Effectiveness of olanzapine for the treatment of breakthrough chemotherapy induced nausea and vomiting. J Med Assoc Thai 97:349–355Google Scholar
  25. 25.
    Bank Indonesia: Foreign exchange reference rates: Jakarta interbank spot dollar rate USD-IDR, 2017Google Scholar
  26. 26.
    Bank of Thailand: foreign exchange rates as of 10 February 2017: weighted-average interbank exchange rate, 2017Google Scholar
  27. 27.
    Central Bank of Malaysia: Ringgit foreign exchange rates, 2017Google Scholar
  28. 28.
    Monetary Authority of Singapore: exchange rates, 2017Google Scholar
  29. 29.
    Health Intervention and Technology Assessment Program: Health Technology Assessment Guideline (ed 2). Nonthaburi, Health Intervention and Technology Assessment Program (HITAP), 2013Google Scholar
  30. 30.
    Bank of Thailand: EC_EI_027 Thailand’s macro economic indicators 1/, Bank of Thailand, 2017Google Scholar
  31. 31.
    Department of Statistics Malaysia: Malaysia @ a Glance: Malaysia, 2017Google Scholar
  32. 32.
    Statistics Indonesia: economic growh of Indonesia of fourth quarter 2016, In (BPS) SI (ed). Jakarta, 2017Google Scholar
  33. 33.
    Department of Statistics Singapore: national accounts: gross domestic product, 2017Google Scholar
  34. 34.
    Mizukami N, Yamauchi M, Koike K, Watanabe A, Ichihara K, Masumori N, Yamakage M (2014) Olanzapine for the prevention of chemotherapy-induced nausea and vomiting in patients receiving highly or moderately emetogenic chemotherapy: a randomized, double-blind, placebo-controlled study. J Pain Symptom Manag 47:542–550. CrossRefGoogle Scholar
  35. 35.
    Navari RM, Gray SE, Kerr AC (2011) Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a randomized phase III trial. J Support Oncol 9:188–195. CrossRefGoogle Scholar
  36. 36.
    Italian Group of Antiemetic Research (1995) Ondansetron versus granisetron, both combined with dexamethasone, in the prevention of cisplatin-induced emesis. Ann Oncol 6:805–810Google Scholar
  37. 37.
    Ruff P, Paska W, Goedhals L, Pouillart P, Rivière A, Vorobiof D, Bloch B, Jones A, Martin C, Brunet R et al (1994) Ondansetron compared with granisetron in the prophylaxis of cisplatin-induced acute emesis: a multicentre double-blind, randomised, parallel-group study. The Ondansetron and Granisetron Emesis Study Group. Oncology 51:113–118Google Scholar
  38. 38.
    Seynaeve C, Schuller J, Buser K, Porteder H, Van Belle S, Sevelda P, Christmann D, Schmidt M, Kitchener H, Paes D et al (1992) Comparison of the anti-emetic efficacy of different doses of ondansetron, given as either a continuous infusion or a single intravenous dose, in acute cisplatin-induced emesis. A multicentre, double-blind, randomised, parallel group study. Ondansetron Study Group. Br J Cancer 66:192–197Google Scholar
  39. 39.
    Caro JJ, Briggs AH, Siebert U, Kuntz KM (2012) Modeling good research practices—overview: a report of the ISPOR-SMDM modeling good research practices task force-1. Value Health 15:796–803CrossRefGoogle Scholar
  40. 40.
    Chan A, Abdullah MM, Ishak WZBW, Ong-Cornel AB, Villalon AH, Kanesvaran R (2016) Applicability of the National Comprehensive Cancer Network/Multinational Association of Supportive Care in Cancer Guidelines for Prevention and Management of Chemotherapy-Induced Nausea and Vomiting in Southeast Asia: a consensus statement. J Glob Oncol 3(6):801–813. CrossRefGoogle Scholar
  41. 41.
    Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, Augustovski F, Briggs AH, Mauskopf J, Loder E (2013) Consolidated health economic evaluation reporting standards (CHEERS) explanation and elaboration: a report of the ISPOR health economic evaluations publication guidelines good reporting practices task force. Value Health 16:231–250CrossRefGoogle Scholar
  42. 42.
    Hesketh PJ, Bohlke K, Lyman GH, Basch E, Chesney M, Clark-Snow RA, Danso MA, Jordan K, Somerfield MR, Kris MG (2016) Antiemetics: American Society of Clinical Oncology focused guideline update. J Clin Oncol 34:381–386. CrossRefGoogle Scholar
  43. 43.
    Herrstedt J, Roila F, Warr D, Celio L, Navari RM, Hesketh PJ, Chan A, Aapro MS (2017) 2016 updated MASCC/ESMO consensus recommendations: prevention of nausea and vomiting following high emetic risk chemotherapy. Support Care Cancer 25:277–288CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Suthan Chanthawong
    • 1
  • Yi Heng Lim
    • 2
  • Suphat Subongkot
    • 1
  • Alexandre Chan
    • 3
    • 4
  • Rizka Andalusia
    • 5
  • Ros Suzanna Ahmad Bustamam
    • 6
  • Nathorn Chaiyakunapruk
    • 2
    • 7
    • 8
    • 9
    Email author
  1. 1.Division of Clinical Pharmacy, Faculty of Pharmaceutical SciencesKhon Kaen UniversityKhon KaenThailand
  2. 2.School of PharmacyMonash University MalaysiaSubang JayaMalaysia
  3. 3.Department of Pharmacy, Faculty of ScienceNational University of SingaporeSingaporeSingapore
  4. 4.Department of PharmacyNational Cancer Centre SingaporeSingaporeSingapore
  5. 5.Department of Research and Development“Dharmais” Cancer HospitalJakartaIndonesia
  6. 6.Department of Radiotherapy & OncologyHospital Kuala LumpurKuala LumpurMalaysia
  7. 7.Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical SciencesNaresuan UniversityPhitsanulokThailand
  8. 8.School of PharmacyUniversity of WisconsinMadisonUSA
  9. 9.Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) PlatformMonash University MalaysiaSubang JayaMalaysia

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