Cost‐effectiveness analysis of aprepitant‐based anti‐emetic regimen for children receiving highly emetogenic chemotherapy: Individual patient data analysis of a randomized trial

Background Aprepitant has been shown to reduce chemotherapy‐induced nausea and vomiting in children receiving highly emetogenic chemotherapy (HEC). In this study, we assessed the cost‐effectiveness of aprepitant for children receiving HEC in India, United Kingdom, and the United States. Procedure We utilized individual patient‐level outcome data from a pediatric randomized trial, which demonstrated the superiority of an aprepitant‐based anti‐emetic prophylaxis over standard ondansetron and dexamethasone for HEC. Health state for each day of follow‐up was analyzed and quality‐adjusted life years (QALYs) were estimated. The incremental cost‐utility ratio (ICUR), incremental cost‐effectiveness ratio (ICER), and net monetary benefit (NMB) for each country were estimated. Sensitivity analyses by varying cost of aprepitant, hospitalization, and health state utility values by ±25% were conducted. Results Use of the aprepitant‐based regimen resulted in gain of 0.0019 QALY per chemotherapy cycle along with cost savings of $22.25, $1335.52, and $6612.10 for India, United Kingdom, and the United States, respectively. The cost savings per QALY was estimated to be $12,355.84 for India, $734,282.90 for the United Kingdom, and $3,567,564.11 for the United States. The cost savings for 50% gain in the percentage of days without grade 3 vomiting was $124.18 for India, $7451.63 for the United Kingdom, and $36,892.76 for the United States. The NMB for gain in QALY was $33.62, $1418.60, and $6727.01 for India, United Kingdom, and the United States, respectively. The estimates remained cost‐effective across all scenarios of the sensitivity analyses. Conclusion Aprepitant‐based anti‐emetic regimen is cost‐effective for children receiving HEC. It results in overall cost savings and reduced healthcare‐resource utilization.