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Cost-effectiveness analysis of olanzapine-containing antiemetic therapy for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in highly emetogenic chemotherapy (HEC) patients

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Abstract

Purpose

Olanzapine-containing regimens have been reported to be effective in preventing CINV following highly emetogenic chemotherapy (HEC), but it is unsure whether it is cost-effective. There has been no cost-effectiveness analysis conducted for olanzapine using costs from the USA. The aim of this study is to determine whether olanzapine-containing antiemetic regimens are cost-effective in patients receiving HEC.

Methods

A decision tree model was constructed to evaluate the cost and health outcomes associated with olanzapine-containing antiemetic regimens and otherwise-identical regimens. One-way sensitivity analyses were conducted to individually investigate the effect of (i) lower complete response (CR) rates of olanzapine, closer to non-olanzapine-containing regimens; (ii) higher FLIE scores for patients who achieved no/incomplete response, closer to FLIE scores of patients achieving a complete response; (iii) differing costs of olanzapine to reflect different costs per hospitals, globally, due to different insurance systems and drug costs; and (iv) varying costs for uncontrolled CINV, to account for varying durations of chemotherapy and accompanying uncontrolled CINV.

Results

Olanzapine regimens have an expected cost of $325.24, compared with $551.23 for non-olanzapine regimens. Meanwhile, olanzapine regimens have an expected utility/index of 0.89, relative to 0.87 for non-olanzapine regimens. Olanzapine-containing regimens dominate non-olanzapine-containing regimens even if CR of olanzapine-containing regimens fall to 0.63. Only when CR is between 0.60 and 0.62 is olanzapine both more effective and more costly.

Conclusion

Olanzapine-containing regimens are both cheaper and more effective in the prophylaxis of CINV in HEC patients, compared with non-olanzapine-containing regimens. Future CINV trial resources should be allocated to understand newer antiemetics and compare them to olanzapine-containing regimens as the control arm. Further analysis should use nationally representative data to examine medication costs by payer type.

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Authors and Affiliations

  1. Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Ronald Chow, Leonard Chiu & Carlo DeAngelis

  2. London Regional Cancer Program, London Health Sciences Centre, University of Western Ontario, London, ON, Canada

    Ronald Chow & Michael Lock

  3. Yale School of Public Health, Yale University, New Haven, CT, USA

    Ronald Chow

  4. Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, USA

    Leonard Chiu

  5. Zealand University Hospital, Roskilde, Denmark

    Jørn Herrstedt

  6. Genolier Cancer Center, Genolier, Switzerland

    Matti Aapro

  7. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

    Carlo DeAngelis

  8. Cancer Care Program, Central and South AmericaWorld Health Organization, AL, Birmingham, USA

    Rudolph M. Navari

Authors
  1. Ronald Chow
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  2. Leonard Chiu
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  4. Matti Aapro
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  5. Michael Lock
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  6. Carlo DeAngelis
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  7. Rudolph M. Navari
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Contributions

All authors contributed substantially to conception and design, or acquisition of data, or analysis and interpretation of data. All authors contributed in drafting the article or revising it critically for important intellectual content. All authors approve the version to be published.

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Correspondence to Ronald Chow.

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Conflict of interest

Mr. Chow has nothing to disclose. Mr. Chiu has nothing to disclose. Dr. Herrstedt reports personal fees from SOBI, personal fees from GSK, outside the submitted work. Dr. Aapro reports personal fees and non-financial support from Multinational Association for Supportive Care in Cancer, personal fees and non-financial support from European Society of Medical Oncology, personal fees and non-financial support from European Cancer Organisation, grants and personal fees from Helsinn, personal fees from Tesaro, grants and personal fees from Sandoz, personal fees from Merck USA, personal fees from Vifor, personal fees from Pfizer, personal fees from Taiho, and personal fees from Kyowa Kirin, outside the submitted work. Dr. Lock reports consulting fees from Ferring, Abbvie, Sanofi, and AstraZeneca in the past 10 years outside the submitted work. Dr. DeAngelis has nothing to disclose. Dr. Navari has nothing to disclose.

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Chow, R., Chiu, L., Herrstedt, J. et al. Cost-effectiveness analysis of olanzapine-containing antiemetic therapy for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in highly emetogenic chemotherapy (HEC) patients. Support Care Cancer 29, 4269–4275 (2021). https://doi.org/10.1007/s00520-020-05977-x

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  • DOI: https://doi.org/10.1007/s00520-020-05977-x

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