Cost-effectiveness analysis of fosaprepitant versus aprepitant-based antiemetic regimens in children receiving highly emetogenic chemotherapy: individual patient-level analysis of a randomised trial
Randomized trial reveals diverging cost-effectiveness of fosaprepitant versus aprepitant in pediatric chemotherapy, indicating economic viability depends on local drug pricing.
Key Points
To evaluate the trial-based cost-effectiveness of intravenous fosaprepitant compared with oral aprepitant regimens in children receiving highly emetogenic chemotherapy from private payer perspectives in India and the USA.
Conducted an individual patient-level cost-utility analysis based on a randomized trial enrolling 279 pediatric cancer patients (140 in the fosaprepitant arm and 139 in the aprepitant arm, both combined with ondansetron and dexamethasone).
Evaluated health outcomes as quality-adjusted life-years (QALYs) and calculated incremental cost-utility ratios (ICURs) and incremental net monetary benefit (iNMB) alongside one-way deterministic sensitivity analyses.
Mean QALYs were 0.0116 in the fosaprepitant group compared with 0.0118 in the aprepitant group, yielding a difference of 0.0002.
In India, fosaprepitant had higher mean costs ($33.94 vs $19.73; difference: $14.21) and an iNMB of –$15.59, demonstrating a lack of cost-effectiveness.
In the USA, fosaprepitant resulted in lower mean costs ($615.92 vs $809.73; difference: –$193.81) and an iNMB of $173.81, demonstrating cost-effectiveness.