Cost-effective use of aprepitant in multiple-day chemotherapy regimens

Background: Aprepitant is a highly effective but expensive antiemetic drug. Repeated treatment with aprepitant is required to control emesis in multiple-day chemotherapy. In the present study, cost-effectiveness analysis was carried out for the use of aprepitant in multiple-day chemotherapy, including FP (5-fluorouracil, cisplatin) for head and neck cancer and BEP (bleomycin, etoposide, cisplatin) for germ cell carcinoma. Patients and Methods: A single center, retrospective study was carried out in 46 patients receiving multiple-day chemotherapy. Standard antiemetic medication included aprepitant for 3 days for FP and for 5 days for BEP, in combination with 5-HT3 receptor antagonist and dexamethasone. In the multiple aprepitant treatment groups, aprepitant was added to the standard medication for another 2 days (FP) or 3 days (BEP). Complete protection (CP: no vomiting, no significant nausea and no rescue) was assessed during 7 days for FP or 9 days for BEP as the primary endpoint. Health states were assessed by quality-adjusted life-year (QALY) using the published utility weights. For cost-effectiveness analysis, the incremental cost-effectiveness ratio (ICER) was calculated, where the difference in the QALY was used. Results: The rate of CP was improved by multiple aprepitant treatment both in FP (54% versus 20%) and BEP (54% versus 0%). The ICERs calculated for FP and BEP were USD 17,167 or GBP 11,135/QALY gained, and USD 38,543 or GBP 25,001/QALY gained, respectively, both of which were within the threshold values configured in the UK or US. Conclusions: Repeated administration of aprepitant was found to be cost-effective for the multiple-day chemotherapy.