Cost-Effectiveness Analysis of Ondansetron and Proch

ostoperative nausea and vomiting (PONV) is a common complication of surgery and anesthesia. PONV can result in physical and physiological complications, including aspiration of vomitus, esophageal trauma (Mallory Weiss s y n d rome or Boerh a a v e ’s syndrome), dehydration, and alkalemia, as well as emotional distress. Avoidance of PONV is a major concern for patients undergoing surgical anesthesia, more so than the issues of pain, dysphoria, decreased mental acuity, and extra cost of postoperative care. The American Society of Health-System Pharmacists therapeutic guidelines on the pharmacologic management of nausea and vomiting recommends a 5-HT3 receptor antagonist or droperidol for the prevention of PONV in adults and pediatric patients. Selective serotonin (5-HT3) receptor antagonists, such as ondansetron, have become one of the most widely p rescribed agents for the prevention of PONV. However, several studies suggest that antiemetics such as droperidol and p rochlorperazine provide comparable or superior clinical efficacy. Cost analyses utilizing outpatient surgical settings indicate that the use of droperidol is also associated with greater cost-effectiveness. Chen et al. reported that prochlorperazine is clinically and statistically superior to ondansetron for the prevention of PONV after total hip replacement or total knee replacement procedures. In 2001, the U.S. Food and Drug Administration added a “black box” warning indicating that droperidol may be associated with torsades de pointes; a coincidental shortage of intravenous p rochlorperazine during the same year may have led to an i n c reased use of 5-HT3 receptor antagonists. 0 1 3 I n t r a v e n o u s p rochlorperazine has recently become available again, but at a higher average wholesale price (AWP): $1.32, 2001 AWP versus $9.56, 2004 AWP for 10 mg single-dose vial. 4 1 6 An increase in price will obviously affect pro c h l o r p e r a z i n e ’s cost-effectiveness and may influence its use in the management of PONV. A review of the literature failed to identify a comparison of the costs and benefits of ondansetron and prochlorperazine for the prevention of PONV. There f o re, we have utilized the pre v i o u s l y published efficacy data conducted for ondansetron and prochlorperazine by Chen et al. to construct a cost-effectiveness analysis for the management of PONV in hospitalized patients using current costs. The main objective of this present study was to evaluate the cost-effectiveness of ondansetron and prochlorperazine in the prevention of PONV following total hip replacement or total knee replacement procedures.