OBJECTIVES

: To perform a complete economic evaluation of palonosetron/ netupitant in combination with dexamethasone, in comparison with the combination of two antiemetics (neurokinin-1 receptor antagonists (NKI) and 5-HT3 receptors antagonist (5-HT3)) and dexamethasone, in patients with chemotherapy-related nausea and vomiting, from the point of view of the Mexican public health system.

METHODS

: According to the drugs included in the national formulary in Mexico, we included as comparators all the possible combinations of aprepitant and fosaprepitant with granisetrón, ondansetron, palonosetrón and tropisetrón; all in combination with dexamethasone. In order to determine the comparative efficacy and safety we perform a systematic review and meta-analysis. According to our results, all the possible combinations had similar safety and efficacy, in terms of number of patients with nausea or vomiting. Therefore, a complete economic evaluation of the cost minimization type was performed. The target population were patients that had chemotherapy-related nausea and vomiting. All costs where consulted from Mexican institutional sources. A deterministic and probabilistic sensitivity analysis were performed in order to evaluate the uncertainty of the model. The probabilistic analysis was performed by Monte Carlo simulation. The perspective of the evaluation was from the Mexican public health system.

RESULTS

: The use of palonosetron/ netupitant in combination with dexamethasone generates savings against all the comparators. The minimum save was $1.14 when compared with fosaprepitant/ondnasetron/dexamethasone, and the maximum save was $30.41 when compared with aprepitant/tropisetrón/dexamethasone. The results from the deterministic sensitivity analysis indicates that the results are conclusive with the base case, in most of the comparisons.

CONCLUSIONS

: Palonosetron/ netupitant in combination with dexamethasone represents a cost saving option when compared with other antiemetics included in the Mexican public health system, for patients with chemotherapy-related nausea and vomiting.