2 __________________________________________ ----_______ Current Issues in Pharmacoeconomics
Serotonin antagonist antiemetics: guidelines for optimal use The implementation of guidelines for the use of serotonin antagonist antiemetic agents resulted in substantial savings in drug acquisition costs while increasing the number of patients treated, report researchers at the Memorial Sloan-Kettering Cancer Center, New York. US. The guidelines were developed by a multidisciplinary team at the cancer centre whose objectives were to: • assure optimal patient care institution-wide • standardise antiemetic regimens • provide an educational tool for physicians, nurses and pharmacists • contain antiemetic drug costs. The guidelines assign an antiemetic regimen to each emetogenic category of chemotherapy regimen (graded from I-V, minimal to high emetogenicity) used at the cancer centre.
Three versions In version 1 of the guidelines, patients receiving a low-level emetogenic chemotherapy regimen were allocated IV dexamethasone only, while patient receiving mild-, moderate- or high-level emetogenic chemotherapy regimens received IV dexamethasone plus IV ondansetron 8, 24 or 32mg, respectively. Two further versions of the guidelines were developed following the introduction of IV and then oral granisetron. Oral ondansetron was also included in version 3 of the guidelines. Projections for 1996 showed that drug acquisition costs for antiemetics were halved following the implementation of the guidelines in 1993, while the number of patients treated per month nearly doubled. Survey results showed that the benefits from antiemetic therapy and patients' compliance with the antiemetic regimens set out in the guidelines were comparable with other published reports and with historical data from the cancer centre using more cumbersome and/or expensive regimens prior to the implementation of the guidelines, note the researchers. They add that the guidelines are easily modified to include new chemotherapeutic agents and more effective antiemetic drugs as they enter the market. Nolte Ml. Berkery R. Pizzo B. Baltzer L. Grossano D. et al. Assuring the optimal use of serotonin antagonist antiemetics: the process for development and implementation of institutional antiemetic guidelines at Memorial Sloan-Kettering Cancer Center. Journal of Clinical Oncology 16: 771-778. Feb 1998 800."'''
PhannacoEconomics & Outcomes News 21 Mar 1998 No. 154
1173-5503l9B10154-0002l$01.rxf> Adla International Limltad 1998. All rights reMrved
