| Summary: | To perform a cost-effectiveness analysis (CEA) between a standard
antiemetic regimen-chlorpromazine + dexamethasone (CPM-DEX)- and a 5-HT3 receptor
antagonist-tropisetron (TROP)--in the control of acute emesis induced by highly
emetogenic chemotherapy in children, considering two analytic perspectives:
hospital and patients. METHODS: The CEA was performed by constructing a decision
tree, for both analytic perspectives, of the possible outcomes of treatment with
TROP (single 0.2 mg/kg i.v.) or CPM (5-15 mg i.v. infusion for 3 doses) plus DEX
(2 mg/m2 i.v. bolus i.v. x2). The patients were stratified by age in two groups
(2-12 and 13-17). To estimate the probability of each endpoint at the decision
tree we have taken as a base a trial developed in the Department of Pediatrics.
Direct medical cost of primary therapy, failure, complications and side effects
were included in the cost calculations. RESULTS: From patients' analytic
perspective, TROP was more cost-effective than CPM-DEX for both groups of
patients. Discrepancy between both analytic perspectives in 13-17 year-old
patient's group was resolved in favour of the option chosen from the patients'
analytic perspective (TROP). Sensitivity analysis showed the reliability of the
results. CONCLUSIONS: 1. TROP was more cost-effective than CPM-DEX. 2. Taking
into account the patients' analytic perspective is essential when we compare
antiemetics pharmacoeconomically. 3. It seems necessary to increase the
effectiveness of TROP in pediatric patients receiving highly emetogenic
chemotherapy with strategies such as the addition of a steroid.
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