Antiemetic overuse is prevalent among patients with cancer receiving emetogenic chemotherapy and leads to unnecessary spending, a study published in JAMA Oncology has shown.1
Antiemetics, including 5-HT3 receptor antagonists, neurokinin receptor 1 antagonists, and dexamethasone, are used as prophylaxis for chemotherapy-induced nausea and vomiting (CINV) in patients with cancer. Newer agents are associated with improved efficacy but are also more expensive than older agents.
In 2013, the American Society of Clinical Oncology (ASCO) published its first guideline discouraging the overuse of expensive antiemetics in patients with low risk for experiencing chemotherapy-induced nausea and vomiting; however, there has been limited research on the prevalence of antiemetic overuse and whether it has changed since the publishing of the 2013 ASCO guidelines.
For the study, investigators analyzed data from 678,220 adults whose chemotherapy was initiated between 2008 and 2015. Results showed that antiemetic use occurred in nearly 25% of patients and those receiving highly emetogenic chemotherapy were most likely to have overuse of antiemetic therapy (32.4%).
Researchers also found that in the 6 months after the guidelines were published, patients had a 7.0% lower likelihood of antiemetic overuse compared with those who received treatment prior to the guidelines being published; however, at 6 months after the guidelines were published, the likelihood of antiemetic overuse was 7.4% (95% CI, 4.6-10.2) higher than before the guidelines.
In terms of cost, antiemetic overuse was associated with higher expenses. Specifically, decreasing the overuse of antiemetic drugs could have paid for more than 6% of the chemotherapy costs.
1. Encinosa W, Davidoff AJ. Changes in antiemetic overuse in response to choosing wisely recommendations. JAMA Oncol. 2016 Sep 15. doi: 10.1001/jamaoncol.2016.2530. [Epub ahead of print]