Lin, S.J., Hatoum, H.T., Buchner, D., Cox, D., & Balu, S. (2012). Impact of 5-HT3 receptor antagonists on chemotherapy-induced nausea and vomiting: A retrospective cohort study. BMC Health Services Research, 12, 215.
To study the effect of step-therapy policy requiring an older 5-HT3 receptor antagonist (RA) prior to palonosetron on the risk of chemotherapy-induced nausea and vomiting (CINV) associated with hospital or emergency department (ED) admissions
Patients with a diagnosis of breast or lung cancer and receiving moderately emetogenic chemotherapy (MEC) (cyclophosphamide, carboplatin) or highly emetogenic chemotherapy (HEC) (cisplatin) were selected from the PharmMetrics claims dataset (providing drug name, quantity dispensed, and length of supply) between January 2005 and June 2008. CINV events were followed for six months from initial chemotherapy administration through ICD-9-CM codes. Study duration was six months from the index chemotherapy date, and antiemetics investigated included dolasetron, granisetron, ondansetron, and palonosetron. Patients were divided into two groups: those initiated with palonosetron and maintained on the drug for the duration of the study and those who began therapy with one of the older 5-HT3 RAs and maintained on the initial drug or alternated between any 5-HT3 RAs. The use of dexamethasone was assessed for both groups. CINV events were calculated using paid and filed claims with ICD-9 codes for nausea, vomiting, or dehydration, and those with hospital admissions were selected.
The study was conducted in multiple settings in the United States. Specific sites were not reported.
All patients were in active antitumor treatment.
This was a longitudinal, retrospective cohort study.
Patients with breast or lung cancer receiving MEC who were initiated and maintained on palonosetron were at significantly lower risk for potentially costly CINV versus those on older 5-HT3 RAs. More studies indicating the impact of step-therapy policy are necessary.
Patients with breast or lung cancer undergoing MEC or HEC who are initiated and maintained on palonosetron experience fewer CINV events compared to patients receiving older 5-HT3 RAs. Nurses should be aware that palonosetron is more expensive than older 5-HT3 RAs, and, thus, patients with low economic status or who are self-insured may not be able to pay for this drug. The reduced antiemetic claims noted here suggest that cost may be equivalent because palonosetron requires fewer doses.