Cost-effectiveness Analysis to Estimate the Appropriate Cost of Prophylactic Antiemetic Therapy for Chemotherapy-induced Nausea and Vomiting

Effective control of chemotherapy-induced nausea and vomiting is essential for treatment continuation; however, to date, the effects have not been adequately evaluated from a health-economic perspective. Therefore, in this study, we aimed to analyze the cost-effectiveness of outpatient cancer chemotherapy from a healthcare-payer perspective using a decision-tree analytical model. We compared a hypothetical case in which prophylactic antiemetic medication was added to standard prophylactic antiemetic therapy to increase by 10％ the proportion of total control with no emesis, nausea, and rescue therapy during the acute (day 1） and delayed (days 2 – 5） phases with those in which standard prophylactic antiemetic therapy alone was administered. Based on the incremental cost-effectiveness ratio (ICER） threshold of 7.5 million JPY/quality-adjusted life year, the appropriate prophylactic antiemetic therapy cost was 3,005 JPY when ICER was equal to the threshold value. Moreover, the cost of setting the ICER at the highest threshold of 15 million JPY/quality-adjusted life year was 5,605 JPY. The one-way sensitivity analysis results were most sensitive to utility values when no total control was achieved. Overall, this study estimated the appropriate prophylactic antiemetic therapy cost to be 3,005 JPY per 10％ improvement in total control during the acute and delayed treatment phases.