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

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Abstract

Purpose

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.

Methods

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.

Result

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.

Conclusion

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.

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Authors and Affiliations

  1. Faculty of Pharmacy, Meijo University, Nagoya, Japan

    Ikuto Tsukiyama

  2. Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Japan

    Ikuto Tsukiyama, Sumiyo Tsukiyama, Masayuki Takeuchi, Masayuki Ejiri, Yusuke Kurose & Hiroko Saito

  3. Center for Advanced Medical and Clinical Research, Nagoya University Hospital, Nagoya, Japan

    Masahiko Ando

  4. Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan

    Ichiro Arakawa

  5. School of Pharmaceutical Sciences, Ohu University, Koriyama, Japan

    Tadao Inoue

  6. Division of Respiratory Medicine and Allergology, School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan

    Etsuro Yamaguchi & Akihito Kubo

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  1. Ikuto Tsukiyama
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  2. Masahiko Ando
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  3. Sumiyo Tsukiyama
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  4. Masayuki Takeuchi
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Correspondence to Akihito Kubo.

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Tsukiyama, I., Ando, M., Tsukiyama, S. et al. Cost-utility analysis of aprepitant for patients who truly need it in Japan. Support Care Cancer 27, 3749–3758 (2019). https://doi.org/10.1007/s00520-019-04672-w

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