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Health economics
Research
Cost-utility and budget impact analyses of the use of NEPA for chemotherapy-induced nausea and vomiting prophylaxis in Italy
  1. Umberto Restelli1,2,
  2. Gabriella Saibene3,
  3. Patrizia Nardulli4,
  4. Roberta Di Turi5,
  5. Erminio Bonizzoni6,
  6. Francesca Scolari1,
  7. Tania Perrone7,
  8. Davide Croce1,2,
  9. Luigi Celio3
  1. 1 Centre for Research on Health Economics, Social and Health Care Management (CREMS), Castellanza, Italy
  2. 2 School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  3. 3 Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
  4. 4 Istituto Tumori Giovanni Paolo II, IRCCS, National Cancer Institute, Bari, Italy
  5. 5 Dipartimento dei Servizi, Azienda Sanitaria Locale Roma 3, Rome, Italy
  6. 6 Department of Clinical Science and Community, Section of Medical Statistics, Biometry and Epidemiology “GA Maccacaro”, University of Milan, Milan, Italy
  7. 7 Department of Medical Affairs, Italfarmaco Spa, Cinisello Balsamo (MI), Italy
  1. Correspondence to Dr Umberto Restelli; urestelli{at}gmail.com

Abstract

Objective To evaluate the efficiency of resources allocation and sustainability of the use of netupitant+palonosetron (NEPA) for chemotherapy-induced nausea and vomiting (CINV) prophylaxis assuming the Italian National Health Service (NHS) perspective. A published Markov model was adapted to assess the incremental cost-utility ratio of NEPA compared with aprepitant (APR) + palonosetron (PALO), fosaprepitant (fAPR) + PALO, APR + ondansetron (ONDA), fAPR + ONDA in patients receiving a highly emetogenic chemotherapy (HEC) and with APR + PALO and fAPR + PALO in patients receiving a moderately emetogenic chemotherapy (MEC).

Setting Oncology hospital department in Italy.

Methods A Markov model was used to determine the impact of NEPA on the budget of the Italian NHS on a 5-day time horizon, corresponding to the acute and delayed CINV prophylaxis phases. Direct medical costs considered were related to antiemetic drugs, adverse events management, CINV episodes management. Clinical and quality of life data referred to previously published works. The budget impact analysis considered the aforementioned therapies plus PALO alone (for HEC and MEC) on a 5-year time horizon, comparing two scenarios: one considering the use of NEPA and one not considering its use.

Primary and secondary outcome measures Incremental cost per quality adjusted life year (QALY) and differential economic impact for the Italian NHS between the two scenarios considered.

Results NEPA is more effective and less expensive (dominant) compared with APR + PALO (for HEC and MEC), fAPR + PALO (for HEC and MEC), APR + ONDA (for HEC), fAPR + ONDA (for HEC). The use of NEPA would lead to a 5-year cost decrease of €63.7 million (€42.7 million for HEC and €20.9 million for MEC).

Conclusions NEPA allows an efficient allocation of resources for the Italian NHS and it is sustainable, leading to a cost decrease compared with a scenario which does not consider its use.

  • NEPA
  • cost-utility analysis
  • budget impact analysis
  • netupitant
  • palonosetron
  • chemotherapy induced nausea and vomiting

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-015645

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    Footnotes

    • Contributors UR participated in the design of the study, adapted the model, performed the economic analysis and drafted the manuscript. GS, PN, RDT and TP participated to the interpretation of the results and critically revised the article. EB participated in the design of the study, in the model adaptation and helped to draft the manuscript. FS participated in the model adaptation and economic analysis and critically revised the article. DC participated in economic analysis and critically revised the article. LC participated in the design of the study and in the adaptation of the model and helped to draft the manuscript. All authors read and approved the final manuscript.

    • Funding The analysis and the article drafting were supported by an unconditional grant from Italfarmaco Spa.

    • Competing interests UR declares advisory board fees from Bayer and Italfarmaco. GS, PN, RDT, FS and DC declare no conflict of interests. EB declares grants from Italfarmaco Spa, Zambon Spa and Polichem SA. TP is employed by Italfarmaco Spa. LC declares personal fees from Italfarmaco Spa and Helsinn Healthcare SA.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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