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

Supportive Care in Cancer volume 27, pages 1109–1119 (2019)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

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

Contributors

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.

Author information

Affiliations

  1. Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand

    Suthan Chanthawong & Suphat Subongkot

  2. School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia

    Yi Heng Lim & Nathorn Chaiyakunapruk

  3. Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore

    Alexandre Chan

  4. Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore

    Alexandre Chan

  5. Department of Research and Development, “Dharmais” Cancer Hospital, Jakarta, Indonesia

    Rizka Andalusia

  6. Department of Radiotherapy & Oncology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia

    Ros Suzanna Ahmad Bustamam

  7. Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand

    Nathorn Chaiyakunapruk

  8. School of Pharmacy, University of Wisconsin, Madison, WI, USA

    Nathorn Chaiyakunapruk

  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) Platform, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia

    Nathorn Chaiyakunapruk

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  1. Suthan Chanthawong
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  2. Yi Heng Lim
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  4. Alexandre Chan
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Correspondence to Nathorn Chaiyakunapruk.

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Chanthawong, S., Lim, Y.H., Subongkot, S. et al. Cost-effectiveness analysis of olanzapine-containing antiemetic therapy for managing highly emetogenic chemotherapy in Southeast Asia: a multinational study. Support Care Cancer 27, 1109–1119 (2019). https://doi.org/10.1007/s00520-018-4400-1

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  • DOI: https://doi.org/10.1007/s00520-018-4400-1

Keywords

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