Pharmacoeconomic Analysis of Prophylactic Treatments for Emesis Secondary to Breast Cancer Chemotherapy
Bibliographic record
Abstract
ABSTRACT The objectives of this study were to perform a cost effectiveness analysis of ondansetron plus dexamethasone against standard metoclopramide antiemetic combinations in the prevention of acute and delayed emesis following breast cancer chemotherapy protocols administered within the institutional setting. A retrospective chart review was conducted on 163 inpatients who received 5-fluorouracil, cyclophosphamide and epirubicin (FEC) or doxorubicin (FAC). The proportion of patients with complete control of emesis within the first 24 hours (acute) and between 24-72 hours after the completion of chemotherapy (delayed) were determined. A comparative cost model was applied from a hospital perspective. Costs of primary therapy, rescue therapy, nursing costs for breakthrough emesis, extended hospitalization for uncontrolled emesis, and side effects were included in this calculation. The percentage of patients in the ondansetron group who experienced complete emesis control in the acute period was 69.4% compared to 49.2% in the metoclopramide group (p=0.015). The incremental cost in the ondansetron group was $26.83 per additional episode of emesis avoided. In the delayed emetic time frame, patients on ondansetron and those on the metoclopramide regimen had comparable rates of complete control of emesis, 58.2% vs. 47.7% (p=0.25), respectively. The incremental ondansetron cost was $80.19 per episode of emesis avoided. The results of this analysis suggest that ondansetron in combination with dexamethasone is an economically attractive treatment strategy in the hospital setting for the prevention of acute emesis. The use of ondansetron beyond the first 24 hours following moderately emetogenic chemotherapy becomes a more expensive treatment. RESUME Le but de cette etude etait de comparer le rapport cout/efficacite de l'association ondansetron-dexamethasone a celui des associations standard d'antiemetiques avec metoclopramide, dans la prevention des vomissements immediats et tardifs consecutifs aux seances de chimiotherapie contre le cancer du sein donnees en milieu hospitalier. Les chercheurs ont mene une analyse retrospective des dossiers therapeutiques de 163 patients hospitalises auxquels on a administre l'association 5-fluorouracil-cyclophosphamide-epirubicine (FEC) ou doxorubicine (FAC). Ils ont evalue le pourcentage de patients qui ont obtenu une parfaite maitrise de leurs vomissements dans les 24 heures suivant la chimiotherapie (vomissements immediats) et dans les 24 a 72 heures apres la chimiotherapie (vomissements tardifs). Un modele de couts compares a ete utilise pour evaluer divers aspects des soins hospitaliers, notamment les couts en terme de traitement principal, de traitement de secours, de soins infirmiers pour les vomissements pertherapeutiques, de sejour prolonge du aux vomissements non maitrises et d'effets indesirables. Le taux de patients du groupe ondansetron ayant obtenu une parfaite maitrise de leurs vomissements immediats a ete de 69,4 %, comparativement a 49,2 % pour les patients du groupe metoclopramide (p = 0,015). Le cout additionnel par episode emetique evite etait de 26,83 $ dans le groupe ondansetron. De plus, le taux de patients ayant obtenu une maitrise parfaite de leurs vomissements tardifs etait semblable pour le groupe ondansetron, 58,2 % et le groupe metoclopramide, 47, 7 % (p = 0,25). Le cout additionnel par episode emetique evite dans ce cas-ci etait de 80, 19 $ pour le groupe ondansetron. Les resultats de cette analyse portent a croire que l'ondansetron associe au dexamethasone constitue une strategie therapeutique economique et interessante pour le milieu hospitalier dans la prevention des vomissements immediats. En revanche, l'utilisation de l'ondansetron apres les 24 premieres heures suivant une chimiotherapie moderement emetogene s'avere plus dispendieux.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".