Health Plan Cost-Savings with Netupitant/Palonosetron for the Prevention of CINV

Laura Morgan

May 2015, Vol 6, No 4 - Economics of Cancer Care


San Diego, CA—According to the National Comprehensive Cancer Network guidelines for the prevention of chemotherapy-induced nausea and vomiting (CINV), highly and moderately emetogenic chemotherapy should be managed with a 5-HT3 receptor antagonist, an NK1 receptor antagonist, and dexamethasone (Decadron).

A recent study by Russell L. Knoth, PharmD, Eisai, Woodcliff Lake, NJ, and colleagues sought to quantify the cost impact of adopting the 5-HT3/NK1 combination netupitant plus palonosetron (Akynzeo) in a US health plan for the prevention of CINV. The study results were presented at the 2015 Academy of Managed Care Pharmacy annual meeting.

Using a decision analytic model, researchers compared the costs of antiemetic prophylaxis during a 3-year period before and after netupitant plus palonosetron became a treatment option in a US health plan.

This analysis was based on the annual plan costs, per-member per-month costs, and the costs per utilizing member. The calculated treatment costs were derived using standard prescribing dosages and current US medication prices.

The researchers identified 1383 patients who were eligible to receive netupitant plus palonosetron for moderately or highly emetogenic chemotherapy. The study’s results revealed that before the adoption of netupitant plus palonosetron, the cost of preventing CINV totaled nearly $4 million (ie, $3,997,255).

After a 3-year period, however, netupitant plus palonosetron reduced the annual cost by $51,227. In addition, the reduced per-member per-month cost for netupitant plus palonosetron resulted in an annual cost-savings of $0.002 in year 1, $0.003 in year 2, and $0.004 in year 3. Finally, a review of the per–utilizing member cost showed that there were only 2 other antiemetic regimens that were less expensive than netupitant plus palonosetron.

Several study limitations may impact the interpretation of these results. For example, the treatment costs were based on current medication prices, which are likely to change.

In addition, the researchers did not account for the costs of patients who may have switched therapy during their chemotherapy cycles.

“Results of the model indicate that adoption of NEPA [netupitant/palonosetron] for the prevention of CINV will have a relatively neutral impact on a U.S. health plan budget,” the researchers concluded.

Nevertheless, this study focused on medication costs alone and did not consider the combination’s established efficacy of reducing the incidence of CINV, which may further confer cost-savings benefits on health plans.