اپرپیتنت برای بیماران تحت شیمی درمانی با امتوجنیک بالا: تجزیه و تحلیل اقتصادی برای سنگاپور
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|29045||2012||9 صفحه PDF||سفارش دهید||5912 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Value in Health Regional Issues, Volume 1, Issue 1, May 2012, Pages 66–74
Background Aprepitant (a neurokinin 1 receptor antagonist), in combination with a serotonin receptor antagonist (5-HT3 RA) and dexamethasone, has demonstrated superior efficacy on end points related to chemotherapy-induced nausea and vomiting (CINV) compared with standard care (combination 5-HT3 RA and dexamethasone). Objective To determine the cost-effectiveness of an aprepitant-containing regimen compared with current clinical practice for the prevention of CINV in patients receiving highly emetogenic chemotherapy (HEC) in Singapore. Methods A decision-analytic model was constructed to assess the costs and outcomes associated with an aprepitant-containing regimen compared with standard care in the prevention of CINV following HEC. Three scenarios were modeled on the basis of results of four double-blind randomized clinical trials of aprepitant. CINV event probabilities were calculated on the basis of the occurrence of nausea and vomiting and the need for rescue medication in the 5 days following a single cycle of HEC. The analysis was conducted from the Singapore health care system perspective. Results Aprepitant reduced emesis and nausea, resulting in small but clinically important improvements when measured in quality-adjusted life-years. The aprepitant-containing regimen was associated with higher acquisition costs but lower costs relating to patient management, hospitalization, and use of rescue medication. Across the scenarios, the incremental cost per emetic event avoided ranged from cost saving to Singapore $63 (US $51). The incremental cost-effectiveness ratio ranged from cost saving to Singapore $49,800 per quality-adjusted life-year gained (US $40,600). The analysis was relatively insensitive to changes in the inputs. Conclusions Aprepitant is a clinically important and cost-effective therapy for the prevention of CINV in patients treated with HEC in Singapore.
Chemotherapy-induced nausea and vomiting (CINV) has been identified as one of the most distressing adverse effects for patients who are being treated with chemotherapy for malignancy 1. If CINV is not well controlled, it can significantly affect a patient's quality of life, leading to poor compliance with further chemotherapy treatment, which can be life-threatening. Chemotherapies are categorized into four CINV categories according to the emetogenic potential of the agent, namely, highly emetogenic agent (90% or more of the patients will experience acute emesis), moderately emetogenic agent (30%–90% of the patients will experience acute emesis), lowly emetogenic agent (10%–30% of the patients will experience acute emesis), and minimally emetogenic agent (<10% of the patients will experience acute emesis) . Aprepitant, a substance P neurokinin 1 receptor antagonist , is indicated for use as part of an antiemetic regimen for the prevention of acute and delayed CINV associated with highly emetogenic chemotherapy (HEC) regimens such as those containing cisplatin or an anthracycline and cyclophosphamide (AC). In clinical trials, aprepitant, in combination with a serotonin receptor antagonist (5-HT3 RA) and dexamethasone, has demonstrated superior efficacy on end points related to CINV compared with a standard care regimen (combination of 5-HT3 RA and dexamethasone) . As a result, in the antiemesis guidelines issued by a few of the key international organizations, such as the Multinational Association of Supportive Care in Cancer, the European Society for Medical Oncology, the National Comprehensive Cancer Network, and the American Society of Clinical Oncology, aprepitant is recommended as part of an antiemetic regimen for patients who are receiving HEC ,  and . In Singapore, aprepitant is indicated for CINV prophylaxis with any HEC or moderately emetogenic chemotherapy regimen and is not restricted for use in specific cancer types . Aprepitant has been assessed and recommended for listing in several markets in the Asia-Pacific region. In 2009, New Zealand added aprepitant to its pharmaceutical schedule for patients undergoing HEC or anthracycline-based chemotherapy for the treatment of malignancy . Similarly, aprepitant is reimbursed in South Korea for use with chemotherapy classified as HEC and patients receiving AC combinations . In Australia, aprepitant is recommended for one cycle in patients undergoing chemotherapy with certain agents, regimens deemed to be highly emetic, and for female breast cancer patients receiving AC combinations . A number of cost-effectiveness analyses of aprepitant have been published [11–13]; however, the value of aprepitant in the context of the Singapore health system has not yet been described. Currently, ondansetron is included in the government standard drug list for patients with CINV. Given that an aprepitant-based regimen has superior efficacy, it is important to understand whether this regimen will be cost-effective in Singapore. Our aim was to assess the cost-effectiveness of an aprepitant-containing regimen compared with current clinical practice for the prevention of CINV in patients receiving HEC in Singapore.
نتیجه گیری انگلیسی
Aprepitant is a clinically important and cost-effective treatment compared with the usual standard of care for the prevention of CINV in patients treated with HEC in Singapore.