Pcn174 - nepa, an oral fixed combination of netupitant and palonosetron, is a cost-effective intervention for the prevention of chemotherapy-induced nausea and vomiting (cinv) in germany and greece

To evaluate the cost-effectiveness of NEPA, an oral fixed combination of netupitant 300mg, and palonosetron (PAL) 0.5 mg, compared with four currently recommended triple-agents anti-emetics to prevent CINV in patients undergoing treatment with highly emetogenic chemotherapy (HEC) in Germany and Greece. A Markov model was developed to estimate the cost-effectiveness of NEPA on a 5-day time horizon, corresponding to the overall CINV phase, using the German and Greek health-care payer perspective. Direct medical costs considered were related to antiemetic drugs and CINV episodes management. Efficacy data of NEPA were taken from NEPA clinical trials while a previously published network meta-analysis was used for comparators’ efficacy. Utilities were obtained from the literature. The primary efficacy outcome considered was quality-adjusted life-days (QALDs). Secondary efficacy outcome was CINV-free patients. Comparators were apreptitant (APR) + ondansetron (OND), APR + PAL, fosaprepitant (FOS) + granisetron (GRA) and rolapitant (ROL) + GRA (Germany only as ROL not available in Greece), third agent being dexamethasone for all regimens. Only cost inputs differed between the two country analyses. NEPA was dominant against all four comparators in Germany, being the cheapest with a total cost of 81.49€ and the most effective with a total QALDs of 4.272. The total differential costs were +35.45€, +37.38€, +68.77€ and +6.89€; the total differential QALDs were respectively -0.0004, -0.0001, -0.0004 and -0.0006 and the proportions of CINV-free patients at 5 days was 83.0% for NEPA and 79.4%, 83.0%, 79.1% and 75.5% for APR+OND, APR+PAL, FOS+GRA and ROL+GRA respectively. NEPA was also dominant against all three comparators in Greece, with a total cost of 85.00€. The differential total costs were +10.46€, +27.07€ and +23.05€ for APR+OND, APR+PAL and FOS+GRA respectively. NEPA is a cost-effective strategy for prevention of CINV in patients undergoing HEC in both Germany and Greece.