Preventing Emesis Can Save Money
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