Poor adherence to recommended prophylaxis has been reported, in several observational studies. Other analysis showed, for patients receiving MEC, that despite the use of antiemetic prophylaxis, 20.8% of patients experienced at least one episode of vomiting, 42% nausea of any intensity and significant nausea in 23.8% of the patients. ĭespite the introduction of more effective antiemetics, up to 20% of cancer patients treated with HEC still suffer from moderate to severe CINV (≥ grade 2). While the emetogenic potential of chemotherapy agents is predictive of CINV, several patient-related risk factors have also been identified, including occurrence of CINV in previous cycle and its duration. CINV is associated with certain chemotherapy agents, e.g., HEC drugs such as cyclophosphamide (> 1500 mg/m 2), cisplatin and carmustine and MEC drugs including doxorubicin, cyclophosphamide (< 1500 mg/m 2), epirubicin and oxaliplatin. Low risk is assigned to 10–30%, moderate risk to 30–90% and high risk > 90% incidence of vomiting. Cancer drugs are classified as either low, minimal, moderate or highly emetogenic risk, based on the risk of vomiting without any antiemetic prophylaxis. Without prophylactic treatment, it is estimated that over 90% of patients exposed to highly emetogenic chemotherapy (HEC) and between 30 and 90% of patients exposed to moderately emetogenic chemotherapy (MEC) will experience acute-phase CINV. ĬINV is classified according to time of onset after chemotherapy administration into acute (occurring within the first 24 h), delayed (between 24 and 120 h) and overall (between 0 and 120 h) phase and may last for several days. Experiencing CINV side effects is not only debilitating to patients but is frequently cited as a major reason for treatment discontinuation. Ī survey among women with breast cancer showed that patients would, on average, risk a 38% chance of being dead to avoid having grade III/IV nausea/vomiting for the rest of their lives, signalling the importance of effective prophylactic treatments for these patients. Based on the Functional Living Index Emesis (FLIE) questionnaire, 37.2% of all patients reported reduced daily functioning, and of those with poorly managed CINV, about 90% reported a significant impact on daily functioning. These results are in line with previously reported analyses throughout different international settings.Ĭhemotherapy-induced nausea and vomiting (CINV) is ranked by patients as one of the most distressing side effects cancer patients experience during chemotherapy and can negatively impact quality of life and the ability to carry out the activities of daily living. ![]() Conclusionīy most evaluations, NEPA is a dominant or cost-effective treatment alternative to current antiemetic standards of care in Spain during the first 5 days of chemotherapy treatment in cancer patients, despite the introduction of generics. ![]() NEPA was dominant (more effective and less costly) against aprepitant combined with palonosetron, and fosaprepitant combined with granisetron, while, compared to generic aprepitant plus ondansetron, NEPA showed an incremental cost per avoided emetic event of €33 and cost per QALD gained of €125. The primary outcomes were cost per avoided emetic event and cost per QALDs gained. Incremental costs including treatment costs and treatment failure management cost as well as incremental effects including quality adjusted life days (QALDs) and emesis-free days were compared between NEPA and the comparator arms. MethodsĪ Markov model including three health states, complete protection, complete response at best and incomplete response, was used to evaluate the cost-effectiveness of NEPA versus common treatment options in Spain during 5 days after chemotherapy. The aim of this study was to assess the cost-effectiveness of NEPA, a fixed-dose combination of oral netupitant (300 mg) and palonosetron (0.5 mg), compared to available treatments in Spain after aprepitant generic introduction in the market, and to discuss results in previously performed analyses in different wordwide settings.
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