Cost-Effectiveness Analysis of Granisetron-Based versus Standard Antiemetic Regimens in Low-Emetogenic Chemotherapy: A Hospital-based Perspective from Malaysia

Background: In a prospective cohort study of antiemetic therapy conducted in Malaysia, a total of 94patients received low emetogenic chemotherapy (LEC) with or without granisetron injections as the primaryprophylaxis for chemotherapy-induced nausea and vomiting (CINV). This study is a retrospective cost analysisof two antiemetic regimens from the payer perspective. Materials and
Methods: This cost evaluation refers to2011, the year in which the observation was conducted. Direct costs incurred by hospitals including the drugacquisition, materials and time spent for clinical activities from prescribing to dispensing of home medicationswere evaluated (MYR 1=$0.32 USD). As reported to be significantly different between two regimens (96.1%vs 81.0%; p=0.017), the complete response rate of acute emesis which was defined as a patient successfullytreated without any emesis episode within 24 hours after LEC was used as the main indicator for effectiveness.
Results: Antiemetic drug acquisition cost per patient was 40.7 times higher for the granisetron-based regimenthan for the standard regimen (MYR 64.3 vs 1.58). When both the costs for materials and clinical activities wereincluded, the total cost per patient was 8.68 times higher for the granisetron-based regimen (MYR 73.5 vs 8.47).Considering the complete response rates, the mean cost per successfully treated patient in granisetron group was7.31 times higher (MYR 76.5 vs 10.5). The incremental cost-effectiveness ratio (ICER) with granisetron-basedregimen, relative to the standard regimen, was MYR 430.7. It was found to be most sensitive to the change ofantiemetic effects of granisetron-based regimen.
Conclusions: While providing a better efficacy in acute emesiscontrol, the low incidence of acute emesis and high ICER makes use of granisetron as primary prophylaxis inLEC controversial.