Netupitant plus palonosetron is a cost-effective treatment for the prophylaxis of chemotherapy-induced nausea and vomiting in highly and moderately emetogenic cancer treatment

ABSTRACT

Introduction: The analysis was conducted to assess a cost-efficacy analysis of new antiemetic drugs (netupitant plus palonosetron (NEPA)) for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in highly and moderately emetogenic chemotherapy for cancer treatment.

Areas covered:The present evaluation was restricted to pivotal phase III randomized controlled trials (RCTs) of NEPA versus (vs.) palonosetron for the prophylaxis of CINV. We calculated the pharmacological costs necessary to get the benefit in complete response (CR), for each trial. Our analysis evaluated 2 RCTs, including 1720 patients. Referring to both highly and moderately emetogenic chemotherapy, NEPA plus DEX was economic superior to palonosetron (PALO) plus DEX, with 13 312 € and 7885 € gain in medical costs every 100 patients treated, respectively. The cost-effectiveness ratios (CERs) (€/CR) in highly emetoge

nic risk were 1.24 and 13.23 for the NEPA and PALO group, respectively and 1.49 and 15.20 for the same groups in moderately emetogenic risk. The incremental cost-effectiveness ratio (ICER) between the groups was 1016.18 €/CR and 1024.03 €/CR in highly and moderately emetogenic risk, respectively.

Expert opinion:The combination of NEPA plus DEX is cost-effective for preventing CINV in highly and moderately (AC-based) emetogenic cancer treatment.

KEYWORDS:

• Highly emetogenic chemotherapy
• moderately emetogenic chemotherapy
• netupitant
• cost of drugs

Article Highlights

• The present evaluation was restricted to pivotal phase III randomized controlled trials (RCTs) of netupitant plus palonosetron (NEPA) versus (vs.) palonosetron for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV) in highly and moderately emetogenic chemotherapy for cancer treatment.

• Our analysis evaluated 2 RCTs, including 1720 patients.

• NEPA plus a single dose of DEX was superior to palonosetron plus DEX in preventing and control CINV following highly and moderately emetogenic chemotherapy in overall phases of observation.

• Combining the costs of antiemetic therapy with the measure of efficacy represented by the CR, we get the costs for obtaining the advantage in CR.

• Referring to both highly and moderately emetogenic chemotherapy, NEPA plus DEX was economic superior to palonosetron plus DEX, with 13 312 € and 7885 € gain in medical costs every 100 patients treated, respectively and with 17 810 € and 10 549 € gain in total costs (medical costs plus indirect costs) every 100 patients treated with NEPA plus DEX vs. palonosetron plus DEX, respectively.

• The cost-effectiveness ratios (CERs) (€/CR) in highly emetogenic risk were 1.24 and 13.23 for the NEPA and PALO group, respectively and 1.49 and 15.20 for the same groups in moderately emetogenic risk.

• The incremental cost-effectiveness ratio (ICER) between the groups was 1016.18 €/CR and 1024.03 €/CR in highly and moderately emetogenic risk, respectively.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

A reviewer on this manuscript has disclosed advisory board honoraria from Italfarmaco SpA. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose

Additional information

Funding

This paper was not funded.