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Costs of Treating and Preventing Nausea and Vomiting in Patients Receiving Chemotherapy

From the Ottawa Regional Cancer Centre, Cancer Care Ontario, and the University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.

Address reprint requests to David J. Stewart, MD, FRCPC, Professor of Medicine & Pharmacology, Head of Medical Oncology, Ottawa Regional Cancer Centre-Civic Division, 190 Melrose Ave, Ottawa, Ontario, Canada, K1Y 4K7; Email dstewart{at}cancercare.on.ca

PURPOSE: To evaluate the effect of ondansetron availability on the costs of managing nausea and vomiting.

METHODS: We retrospectively assessed antiemetic costs (drug costs, nursing time, pharmacy time, physician's time, supplies, and facility "hotel" costs, in 1991 Canadian dollars) for all patients who received moderately or highly emetogenic chemotherapy from 6 months before to 6 months after ondansetron became commercially available in September 1991. We compared the costs for treating patients who received ondansetron versus those who received other antiemetic regimens, the costs for treating patients in the 6 months before versus the 6 months after ondansetron commercial availability, and the costs for treating patients in the first 4 months versus the last 4 months of the study period.

RESULTS: We found no cost differences for patients treated with ondansetron versus other antiemetic regimens. However, there was a significant reduction in emesis management costs for patients treated after versus before the availability of ondansetron: for patients treated in the last third versus first third of the study period, there was a decrease in cost per patient per month of treatment of $374 (95% confidence interval, $243 to $505). These savings were achieved through a reduction in hospital bed days and other costs associated with the prevention and more effective management of nausea and vomiting. At the same time, the number of patients who received emetogenic chemotherapy and their average age increased, presumably because of the better control of gastrointestinal toxicity.

CONCLUSION: Ondansetron availability has been associated with changes in the clinical management of cancer patients receiving chemotherapy and with overall cost savings compared with previously available antiemetic therapy.

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