Supportive Care in Cancer

, Volume 27, Issue 10, pp 3749–3758 | Cite as

Cost-utility analysis of aprepitant for patients who truly need it in Japan

  • Ikuto Tsukiyama
  • Masahiko Ando
  • Sumiyo Tsukiyama
  • Masayuki Takeuchi
  • Masayuki Ejiri
  • Yusuke Kurose
  • Hiroko Saito
  • Ichiro Arakawa
  • Tadao Inoue
  • Etsuro Yamaguchi
  • Akihito KuboEmail author
Original Article



Neurokinin-1 receptor antagonist (NK1RA) is recommended to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly or moderately emetogenic chemotherapy (HEC or MEC, respectively). We previously reported that aprepitant, an NK1RA, was needed to control CINV in 43% and 12% of patients who received HEC and MEC, respectively (Support Care Cancer 23:905–912, 2015). To elucidate the cost-effectiveness of aprepitant in these patients, a cost-utility analysis according to the necessity of aprepitant was performed.


A decision-analytic model was developed according to the necessity of aprepitant and CINV responses in both acute and delayed phases of chemotherapy. Probabilities of health states and medical costs were derived from the results of the abovementioned trial.


In patients who received HEC and needed aprepitant, the incremental cost-effectiveness ratio (ICER) with aprepitant, relative to the regimen with no aprepitant, was 7912 US dollars (USD) per quality-adjusted life year (QALY) gained, which was far below the commonly accepted threshold of 50,000 USD/QALY. The ICER was 27,457 USD/QALY in patients who received MEC and needed aprepitant. In contrast, in patients who received HEC or MEC but did not need aprepitant, the ICER was 175,959 or 478,844 USD/QALY, respectively.


Regardless of whether a patient received HEC or MEC, aprepitant use was highly cost-effective for patients who truly needed it. These results warrant further research to predict the necessity of NK1RA treatment before initiating emetogenic chemotherapies.


Aprepitant Neurokinin-1 receptor antagonist (NK1RA) Cost-effectiveness Highly emetogenic chemotherapy (HEC) Moderately emetogenic chemotherapy (MEC) Incremental cost-effectiveness ratio (ICER) 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ikuto Tsukiyama
    • 1
    • 2
  • Masahiko Ando
    • 3
  • Sumiyo Tsukiyama
    • 2
  • Masayuki Takeuchi
    • 2
  • Masayuki Ejiri
    • 2
  • Yusuke Kurose
    • 2
  • Hiroko Saito
    • 2
  • Ichiro Arakawa
    • 4
  • Tadao Inoue
    • 5
  • Etsuro Yamaguchi
    • 6
  • Akihito Kubo
    • 6
    Email author
  1. 1.Faculty of PharmacyMeijo UniversityNagoyaJapan
  2. 2.Department of PharmacyAichi Medical University HospitalNagakuteJapan
  3. 3.Center for Advanced Medical and Clinical ResearchNagoya University HospitalNagoyaJapan
  4. 4.Faculty of Pharmaceutical SciencesTeikyo Heisei UniversityTokyoJapan
  5. 5.School of Pharmaceutical SciencesOhu UniversityKoriyamaJapan
  6. 6.Division of Respiratory Medicine and Allergology, School of MedicineAichi Medical UniversityNagakuteJapan

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