NEPA, a new fixed combination of netupitant and palonosetron, is a cost-effective intervention for the prevention of chemotherapy-induced nausea and vomiting in the UK

NEPA, a new fixed combination of netupitant and palonosetron, is a cost-effective intervention for the prevention of chemotherapy-induced nausea and vomiting in the UK

Article Details

Authors
Helene Cawston, Francois Bourhis, Jennifer Eriksson, Pierfrancesco Ruffo, Paolo D’Agostino, Marco Turini, Lee Schwartzberg, Alistair McGuire

Article Type
Review

DOI
10.7573/dic.212298

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Abstract 

Background: The objective was to evaluate the cost-effectiveness of NEPA, an oral fixed combination netupitant (NETU, 300 mg) and palonosetron (PA, 0.5 mg) compared with aprepitant and palonosetron (APPA) or palonosetron (PA) alone, to prevent chemotherapy-induced nausea and vomiting (CINV) in patients undergoing treatment with highly or moderately emetogenic chemotherapy (HEC or MEC) in the UK.

Scope: A systematic literature review and meta-analysis were undertaken to compare NEPA with currently recommended anti-emetics. Relative effectiveness was estimated over the acute (day 1) and overall treatment (days 1–5) phases, taking complete response (CR, no emesis and no rescue medication) and complete protection (CP, CR and no more than mild nausea [VAS scale <25 mm]) as primary efficacy outcomes. A three-health-state Markov cohort model, including CP, CR and incomplete response (no CR) for HEC and MEC, was constructed. A five-day time horizon and UK NHS perspective were adopted. Transition probabilities were obtained by combining the response rates of CR and CP from NEPA trials and odds ratios from the meta-analysis. Utilities of 0.90, 0.70 and 0.24 were defined for CP, CR and incomplete response, respectively. Costs included medications and management of CINV-related events and were obtained from the British National Formulary and NHS Reference Costs. The expected budgetary impact of NEPA was also evaluated.

Findings: In HEC patients, the NEPA strategy was more effective than APPA (quality-adjusted life days [QALDs] of 4.263 versus 4.053; incremental emesis-free and CINV-free days of +0.354 and +0.237, respectively) and was less costly (£80 versus £124), resulting in NEPA being the dominant strategy. In MEC patients, NEPA was cost effective, cumulating in an estimated 0.182 extra QALDs at an incremental cost of £6.65 compared with PA.

Conclusion: Despite study limitations (study setting, time horizon, utility measure), the results suggest NEPA is cost effective for preventing CINV associated with HEC and MEC in the UK.

Keywords: antiemetics, cost-effectiveness, medical oncology, meta-analysis, nausea, netupitant, palonosetron, quality of life, review literature, vomiting.

Abbreviations: 5-HT3, 5-HT3 receptor antagonist; AE, adverse event; APPA, aprepitant and palonosetron; APR, aprepitant; ASCO, American Society of Clinical Oncology; BNF, British National Formulary; CI, confidence interval; CINV, chemotherapy-induced nausea and vomiting; CP, complete protection; CR, complete response; CrI, credible interval; DIC, deviance information criterion; DSA, deterministic sensitivity analysis; ESMO, European Society for Medical Oncology; HEC, highly emetogenic chemotherapy; HTA, health technology assessment; ICER, incremental cost-effectiveness ratio; IV, intravenous; MASCC, The Multinational Association of Supportive Care in Cancer; MEC, moderately emetogenic chemotherapy; mg, milligram; MIMS, Monthly Index of Medical Specialities; MTC, Mixed Treatment Comparison; NA, not available; NCCN, National Comprehensive Cancer Network; NEPA, netupitant and palonosetron fixed combination; NETU, netupitant; NHS, National Health Service; NICE, National Institute for Health and Clinical Excellence; NK1, NK1 receptor antagonist; OR, odds ratio; PA, palonosetron; PICOS, Population, Interventions, Comparators, Outcomes and Study design; PO, per os; PSA, probabilistic sensitivity analysis; PSSRU, Personal Social Services Research Unit; QALD, quality-adjusted life-days; QALY, quality-adjusted life-years; RA, receptor antagonist; RR, response rate; TC, total control; UK, United Kingdom; VAS, visual analogue scale; WTP, willingness to pay

Citation: Cawston H, Bourhis F, Eriksson J, Ruffo P, D’Agostino P, Turini M, Schwartzberg L, McGuire A. NEPA, a new fixed combination of netupitant and palonosetron, is a cost-effective intervention for the prevention of chemotherapy-induced nausea and vomiting in the UK. Drugs in Context 2017; 6: 212298. DOI: 10.7573/dic.212298

Contributions: François Bourhis programmed the model and co-drafted the manuscript with Hélène Cawston, who also conducted the targeted literature search in support of the model. All authors were instrumental in the conceptual design and participated extensively in the review and editing of the model and manuscript.

Disclosure and potential conflicts of interest: Hélène Cawston, François Bourhis and Jennifer Eriksson have provided consulting services to Helsinn Healthcare SA. Pierfrancesco Ruffo, Paolo D’Agostino and Marco Turini are employees of Helsinn Healthcare SA. Lee Schwartzberg and Alistair McGuire have provided consulting services to Helsinn Healthcare SA.

The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at http://www.drugsincontext.com/wp-content/uploads/2017/03/dic.212298-COI.pdf.

Funding declaration: The study was supported by Helsinn Healthcare SA.

Copyright: Copyright © 2017 Cawston H, Bourhis F, Eriksson J, Ruffo P, D’Agostino P, Turini M, Schwartzberg L, McGuire A. Distributed under the terms of the Creative Commons License Deed CC BY NC ND 3.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2017 Cawston H, Bourhis F, Eriksson J, Ruffo P, D’Agostino P, Turini M, Schwartzberg L, McGuire A. https://doi.org/10.7573/dic.212298. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 3.0.

Article URL: http://www.drugsincontext.com/nepa-a-new-fixed-combination-of-netupitant-and-palonosetron-is-a-cost-effective-intervention-for-the-prevention-of-chemotherapy-induced-nausea-and-vomiting-in-the-uk

Correspondence: Francois Bourhis, Mapi Group, Nanterre, France. fbourhis@mapigroup.com

Submitted: 3 June 2016; Peer review comments to author: 24 June 2016; Revised manuscript received: 22 December 2016; Publication date: 24 March 2017

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