Abstract
Purpose
To assess the cost-effectiveness of prophylactic therapy (1.25 mg droperidol or 50 mg dolasétroniv) vs no prophylaxis (rescue therapy) for the prevention of post-operative nausea and vomiting (PONV) from a Canadian hospital perspective.
Methods
Design: A predictive decision analytic model using previously published clinical and economic evaluations, and costs of medical care in Canada. Subjects: Ambulatory gynecology surgery patients,Interventions: Three strategies administered prior to emergence from anesthesia were compared: 1.25 mg droperidoliv, 50 mg dolasétroniv; and no prophylaxis (rescue therapy).
Results
The base case mean cost per patient receiving dolasétron prophylaxis was $28.08 CAN compared with $26.88 CAN per patient receiving droperidol prophylaxis, resulting in a marginal cost of $ 1.20 CAN. This difference translated in an additional cost of $ 12.00 CAN for the dolasétron strategy per adverse event avoided over the droperidol strategy. The base case mean cost per patient not receiving prophylaxis was $26.92 resulting in marginal costs of $ 1.16 CAN and $0.04 CAN when compared to dolasétron and droperidol, respectively. Compared with the no prophylaxis strategy, dolasétron prophylaxis resulted in an incremental cost-effectiveness ratio of $5.82 CAN per additional PONV-free patient. The mean costs incurred per PONV-free patient were calculated to be $48.41 for the dolasétron strategy, $46.34 for the droperidol strategy and $70.83 for the no prophylaxis strategy.
Conclusions
Dolasetron and droperidol given intraoperatively were more cost-effective than no prophylaxis for PONV in patients undergoing ambulatory gynecologic surgery. The difference between the two agents was small and favoured droperidol. The model was robust to plausible changes through sensitivity analyses.
Résumé
Objectif
Évaluer la rentabilité d’une thérapie prophylactique (1,25 mg de dropéridol ou 50 mg de dolasétroniv) vs aucune prophylaxie dans le but de prévenir les nausées et vomissements postopératoires (NVPO) dans le contexte d’un hôpital canadien.
Méthode
Devis derecherche: Un modèle analytique de décision prédictive basé sur les évaluations cliniques et économiques déjà publiées et sur le coût des soins médicaux au Canada.Sujets: Patientes de chirurgie gynécologique ambulatoire.Interventons: Trois prescriptions administrées avant le réveil ont été comparées; 1,25 mg de dropéridoliv, 50 mg dolasétroniv; et aucune prophylaxie.
Résultats
Le coût moyen de base par patient qui a reçu du dolasétron a été de 28,08 $ CAN comparé à 26,88 $ par patient qui a reçu du dropéridol, une différence de 1,20 $. Cette différence s’est traduite en un coût additionnel de 12,00 $ CAN, avec la thérapie au dolasétron comparée à la thérapie au dropéridol, pour chaque événement défavorable évité. Le coût de base moyen par patient sans prophylaxie était de 26,92 $ établissant une différence de 1, 16 $ et 0,04 $ comparé au dolasétron et au dropéridol, respectivement. Comparée à la stratégie de non-prophylaxie, la prophylaxie au dolasétron a entraîné une rentabilité accrue au coût de 5,82 $ par patient supplémentaire sans NVPO. Le coût moyen encouru par patient sans NVPO a été de 48,41 $ avec le dolasétron, de 46,34 $ avec le dropéridol et de 70,83 $ sans mesure de prévention.
Conclusion
Le dolasétron et le dropéridol administrés pendant l’opération ont été plus rentables que l’absence de prophylaxie des NVPO chez des patientes subissant une intervention gynécologique ambulatoire. La différence de rentabilité était mince entre les deux médicaments, mais favorisait le dropéridol. C’est un modèle valable pour amener des changements plausibles dans les analyses de sensibilité.
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References
Wetchler BV. Postoperative nausea and vomiting in daycase surgery. Br J Anaesth 1992; 69: 33S-9.
Haigh CG, Kaplan LA, Durham JM, Dupeyron JP, Harmer M, Kenny GNC. Nausea and vomiting after gynaecological surgery: a meta-analysis of factors affecting their incidence. Br J Anaesth 1993; 71: 517–22.
Madej TH, Simpson KH. Comparison of the use of domperidone, droperidol, and metoclopramide in the prevention of nausea and vomiting following major gynaecological surgery. Br J Anaesth 1986; 58: 884–7.
Sanchez LA, Hirsch JD, Carroll NV, Miederhoff PA. Estimation of the cost of postoperative nausea and vomiting in an ambulatory surgery center. J Res Pharm Econ 1995; 6: 35–44.
Malins AF, Field JM, Nesling PM, Cooper GM. Nausea and vomiting after gynaecological laparoscopy: comparison of premedication with oral ondansetron, metoclopramide, and placebo. Br J Anaesth 1994; 72: 231–3.
Graczyk SG, McKenzie R, Kallar S, et al. Intravenous dolasetron for the prevention of postoperative nausea and vomiting after outpatient laparoscopic gynecologic surgery. Anesth Analg 1997; 84: 325–30.
Helmers JH, Briggs L, Abrahamsson J, et al. A singleiv dose of ondansetron 8 mg prior to induction of anaesthesia reduces postoperative nausea and vomiting in gynaecological patients. Can J Anaesth 1993; 40: 1155–61.
Orkin FK. What do patients want? — preferences for immediate postoperative recovery. Anesth Analg 1992; 74: S225.
Tang J, Watcha MF, White PF. A comparison of costs and efficacy of ondansetron and droperidol as prophylactic antiemetic therapy for elective outpatient gynecologic procedures. Anesth Analg 1996; 83: 304–13.
Gold BS, Kitz DS, Lecky JH, Neuhaus JM. Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989; 262: 3008–10.
Fancourt-Smith PF, Harnstein J, Jenkins LC. Hospital admissions from the Surgical Day Care Centre of Vancouver General Hospital 1977–1987. Can J Anaesth 1990; 37: 699–704.
Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery — a prospective study. Can J Anaesth 1998; 45: 612–9.
Paxton LD, McKay AC, Mimkhur RK. Prevention of nausea and vomiting after day case gynaecologocial laparoscopy. A comparison of ondansetron, droperidol, metoclopramide, and placebo. Anaesthesia 1995; 50: 403–6.
Sniadach MS, Alberts MS. A comparison of the prophylactic antiemetic effect of ondansetron and droperidol on patients undergoing gynecologic laparoscopy. Anesth Analg 1997; 85: 797–800.
Diemunsch P, Leeser J, Feiss P, et al. Intravenous dolasetron mesilate ameliorates postoperative nausea and vomiting. Can J Anaesth 1997; 44: 173–81.
Melnick BM. Extrapyramidal reactions to low-dose droperidol. Anesthesiology 1988; 69: 424–6.
Melnick B, Sawyer R, Karambelker D, Phitayakorn P, Uy NTL, Patel R. Delayed side effects of droperidol after ambulatory general anesthesia. Anesth Analg 1989; 69: 748–51.
Russell D, Kenny GNC. 5-HT3 antagonists in postoperative nausea and vomiting. Br J Anaesth 1992; 69(Suppl 1): 63S-8.
Warriner CB, Knox D, Belo S, Cole C, Finegan BA, Perreault L. Prophylactic oral dolasetron mesylate reduces nausea and vomiting after abdominal hysterectomy. Can J Anaesth 1997; 44: 1167–73.
Diemunsch P, D’Hollander A, Paxton L, et al. Intravenous dolasetron mesilate in the prevention of postoperative nausea and vomiting in females undergoing gynecological surgery. J Clin Anesth 1997; 9: 365–73.
Kortilla K, Clergue F, Leeser J, et al. Intravenous dolasetron and ondansetron in prevention of postoperative nausea and vomiting: a multicenter, double-blind, placebo-controlled study. Acta Anaesthesiol Scand 1997; 41: 914–22.
Desilva PHDP, Darvish AH, McDonald SM, Cronin MK, Clark K. The efficacy of prophylactic ondansetron, droperidol, perphenazine, and metoclopramide in the prevention of nausea and vomiting after major gynecological surgery. Anesth Analg 1997; 85: 797–800.
Paech MJ, Pavy TJG, Evans SF. Single-dose prophylaxis for postoperative nausea and vomiting after major abdominal surgery: ondansetron versus droperidol. Anaesth Intensive Care 1995; 23: 548–54.
Pueyo FJ, Carrascosa F, Lopez L, Iribarren MJ, Garcia-Pedrajas F, Saez A. Combination of ondansetron and droperidol in the prophylaxis of postoperative nausea and vomiting. Anesth Analg 1996; 83: 117–22.
Grond S, Lynch J, Diefenbach C, Altrock K, Lehmann KA. Comparison of ondansetron and droperidol in the prevention of nausea and vomiting after inpatient minor gynecologic surgery. Anesth Analg 1995; 81: 603–7.
Wrench IJ, Ward JEH, Walder AD, Hobbs GJ. The prevention of postoperative nausea and vomiting using a combination of ondansetron and droperidol. Anaesthesia 1996; 51: 776–8.
Watcha MF, Smith I. Cost-effectiveness analysis of antiemetic therapy for ambulatory surgery. J Clin Anesth 1994; 6: 370–7.
Diemunsch P, Conseiller C, Clyti N, Mamet JP, and theFrench Ondansetron Study Group. Ondansetron compared with metoclopramide in the treatment of established postoperative nausea and vomiting. Br J Anaesth 1997; 79: 322–6.
Lacroix G, Lessard MR, Trépanier CA. Treatment of postoperative nausea and vomiting: comparison of propofol, droperidol and metoclopramide. Can J Anaesth 1996; 43: 115–20.
Hull RD, Raskob GE, Rosenbloom D, et al. Treatment of proximal vein thrombosis with subcutaneous low-molecular-weight heparin vs. intravenous heparin. An economic perspective. Arch Intern Med 1997; 157: 289–94.
Frighetto L, Nickoloff D, Jewesson P. Antibiotic therapeutic interchange program: six years of experience. Hosp Formul 1995; 30: 92–105.
Canadian Coordinating Office for Health Technology Assessment. Guidelines for economic evaluation of Pharmaceuticals: Canada, 2nd ed. Ottawa (ON): The Office; 1997.
Magid D, Douglas JM Jr, Schwartz JS. Doxycycline compared with azithromycin for treating women with genitalChlamydia trachomatis infections: an incremental cost-effectiveness analysis. Ann Intern Med 1996; 124: 389–99.
Bootman JL, Townsend RJ, McGhan WE. Introduction to pharmacoeconomics.In: Principles of Pharmacoeconomics, 2nd ed. Cincinnati, OH: Harvey Whitney Books Co. 1996: 5–18.
Tang J, Wang B, White PF, Watcha MF, Qi J, Wender RH. The effect of timing of ondansetron administration on its efficacy, cost-effectiveness, and cost-benefit as a prophylactic antiemetic in the ambulatory setting. Anesth Analg 1998; 86: 274–82.
Cieslak GD, Watcha MF, Philips MB, Pennant JH. The dose-response relation and cost-effectiveness of granisetron for the prophylaxis of pediatric postoperative emesis. Anesthesiology 1996; 85: 1076–85.
Diemunsch P, Leeser J, Helmers JH, et al. Oral dolasetron mesylate for the prevention of postoperative nausea and vomiting (PONV). Anesthesiology 1996; 85: A3.
Diemunsch P, Kovac A, Whitmore J, Hahne W. Dolasetron mesilate prevents and treats postoperative nausea and vomiting in female patients undergoing gynaecological surgery via laparoscopy. Eur J Anaesth 1997; 14: 84.
Nappi J, Nickman N, Gilmore J, Garriga J, Hirsch JD, Sanchez L. A pilot study for the economic evaluation of post-operative nausea and vomiting in ambulatory surgery patients (abstract). American College of Clinical Pharmacy 1992 Winter Forum.
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Frighetto, L., Loewen, P.S., Dolman, J. et al. Cost-effectiveness of prophylactic dolasétron or droperidolvs rescue therapy in the prevention of PONV in ambulatory gynecologic surgery. Can J Anesth 46, 536–543 (1999). https://doi.org/10.1007/BF03013543
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DOI: https://doi.org/10.1007/BF03013543