Preventing Emesis Can Save Money

Wayne Kuznar

February 2011, Vol 2, No 1 - Meeting Highlights

Anaheim, CA—Assessing palonosetron use for the prevention of emesis associated with chemotherapy has the potential to differentiate appropriate and inappropriate use and can lead to cost-savings, said John P. Jezak, PharmD, a pharmacy practice resident at Dartmouth-Hitchcock Medical Cen – ter, Lebanon, NH, at the American Society of Health-System Pharmacists.

Palonosetron, like the other 5-HT3 antagonists, is indicated for the prevention of emesis with high- and moderate- risk emetic regimens. It has been shown to be superior to other 5-HT3 antagonists for the prevention of delayed emesis only, probably owing to its long half-life (approximately 40 hours), notes Dr Jezak.

5-HT3 antagonists were recommended by the National Compre – hensive Cancer Network (NCCN) for use in high- and moderate-emetic risk chemotherapy, but “the NCCN guidelines don’t really differentiate if there’s a preferential antiemetic drug for a specific clinical situation,” he said. Palonosetron has a 50-fold greater average wholesale price (AWP) than ondansetron, so curbing inappropriate use could result in substantial savings, he said. Dr Jezak conducted a retrospective evaluation of 129 patients (involving 269 encounters) who received palo – nosetron at the Dartmouth-Hitchcock infusion center over a 2-month period in 2010. Each patient’s chemotherapy regimen was evaluated on the level of acute and delayed emesis potential.

Any patient who had delayed-onset risk of emesis, based on the 4 regimens listed in the NCCN criteria, was automatically deemed appropriate for palonosetron use.

“The other qualifier we used is failure of another 5-HT3, such as ondansetron. It would also be appropriate to use palonosetron in this type of patient,” Dr Jezak stated.

Potential interchange of palonosetron with another 5-HT3 antagonist would be appropriate if the chemotherapy regimen carried either high or moderate risk for emesis, there was no prior failure with ondansetron, and no risk of delayed-onset emesis.

Pharmacist intervention identified 47 cases of inappropriate palonoset ron use and 17 cases for a potential 5-HT3 interchange.

Preventing inappropriate use had the potential to result in a cost-savings of $8792 during the 2-month study period, assuming that the actual drug acquisition cost was 65.93% below AWP.

The ease of the intervention—a simple phone call—argues for its use, Dr Jezak said