OBJECTIVES: Chemotherapy-induced nausea and vomiting (CINV) is a common side-effect experienced by cancer patients undergoing chemotherapy. The oral fixed-dose combination of netupitant/palonosetron (NEPA) was register in Brazil in 2017. This associate offers a convenient and simplified prophylactic antiemetic. The objective was to assess the cost-effectiveness of NEPA compared fosaprepitant associate with palonosetron for the management of highly emetogenic chemotherapy (HEC) in Brazilian private healthcare system (PHS).

METHODS: A Markov model of two health states, complete response and incomplete response were used. All patients entered the Markov model on the first day of HEC, including the administration of prophylactic antiemetics. Time horizon was four 5-day HEC cycles (first day in an acute phase and the second to fifth days in a delayed phase). Efficacy parameters were extracted from NEPA phase III clinical trial. Costs included were treatment acquisition, hospitalization, and outpatient care. Alternative scenarios considered intravenous (IV) and oral ondasetron as comparator. Deterministic and probabilistic sensitivity analyses were conducted.

RESULTS: NEPA showed an incremental Quality-adjusted life days (QALD) of 1.27 for all scenarios. The base case analysis NEPA presented a total cost saving of R$ 2,883. compared to fosaprepitant with palonosetron, vs ondasetron IV, NEPA saved R$ 1,623.75 and compared to oral ondasetron, NEPA demostrated an incremental cost of R$ 623,42.

CONCLUSIONS: This study demonstrates that, in comparison to fosaprepritant with palonosetron and ondasetron IV, NEPA is a dominant strategy for treatment of CINV and generates an ICER of R$ 179.434,19 when compared with ondasetron oral, the PSH does not have an explicit threshold for cost effectiveness. It’s important to say that the use of ondasetron monotherapy although part of Brazilian clinical practices, it is not provided in the NCCN guideline.