目的:2016年发表了最新的MASCC/ESMO指南,建议预防中度致吐性化疗引起的急性和迟发性呕吐,其中包括蒽环类方案作为高度致吐性化疗(HEC),建议三联止吐疗法控制恶心和呕吐。同样,他们推荐卡铂三联疗法。本研究的目的是分析接受HEC和卡铂治疗的患者在化疗门诊使用的指南和止吐预防之间的一致性程度,评估其有效性,并确定与口服(或)静脉注射(iv)地塞米松(NEPAd)相比,口服使用依替匹坦/帕洛诺司琼(NEPA)与静脉注射(iv)地塞米松(FODiv)相比的节省。
方法:前瞻性观察研究记录人口统计学变量,化疗方案,肿瘤位置,患者呕吐风险,规定的止吐方案,符合MASCC/ESMO指南,和有效性,通过MASCC调查评估,使用抢救药物和因呕吐而到急诊科或住院。进行了成本最小化的药物经济学研究。
结果:纳入61例患者;70%为女性;中位年龄60.5岁。铂金计划在第一阶段更为频繁,为87.5%,而第二阶段为67.6%。蒽环类方案在每个时期分别为21.6%和10%。21.1%的止吐方案与MASCC/ESMO建议不一致,完全在第一阶段。在急性恶心中,有效性问卷的得分是总保护在90.9%,从100%急性呕吐和迟发性恶心,延迟呕吐占72.7%。在第1阶段,使用救护药物的频率为18.7%,在第2阶段没有必要。在任何时期都没有发现急诊室或入院。
结论:使用NEPAd导致使用FOD的成本降低28%。在我们领域最新发布的指南和医疗保健实践之间的两个时期都获得了高度的一致性。对患者进行的调查似乎表明,两种止吐疗法在临床实践中具有相似的有效性。NEPAd的加入导致了成本的降低,将自己定位为一个有效的选择。
Latest MASCC/ESMO
guidelines of the recommendations for the prophylaxis of acute and delayed emesis induced by moderately emetogenic chemotherapy was published in 2016 incorporating anthracycline schemes as highly emetogenic chemotherapy (HEC), proposing triple antiemetic therapy to control nausea and vomiting. Likewise, they recommend triple therapy for
carboplatin. The objectives of this study were to analyze the degree of concordance between
guidelines and antiemetic prophylaxis used in the Chemotherapy Outpatient Unit in patients undergoing treatment with HEC and
carboplatin, to evaluate its effectiveness and to determine the savings due to the use of netupitant/palonosetron (NEPA) oral (or) with intravenous (iv) dexamethasone (NEPAd) compared to iv Fosaprepitant with ondansetron and dexamethasone (FOD iv).
Prospective observational study recording demographic variables, chemotherapy protocol, tumor location, patient emetogenic risk, antiemetic regimen prescribed, concordance with the MASCC/ESMO guideline, and effectiveness, evaluated by MASCC survey, use of rescue medication and visits to the Emergency Department or hospitalization due to emesis. A cost minimization pharmacoeconomic study was carried out.
61 patients were included; 70% women; median age 60.5. Platinum schemes were more frequent in period 1, being 87.5% compared to 67.6% in period 2. Anthracycline schemes were 21.6% and 10% respectively in each period. A 21.1% of the antiemetic regimens did not coincide with the MASCC/ESMO recommendations, being entirely in period 1. The score of the effectiveness questionnaires was total protection in 90.9% in acute nausea, from 100% in acute vomiting and delayed nausea, and 72.7% in delayed vomiting. The frequency of use of rescue medication was 18.7% in period 1 and was not necessary in period 2. No visits to the emergency room or admissions were detected in any of the periods.
Use of NEPAd led to a 28% reduction in costs with respect to the use of FOD. A high level of concordance was obtained in both periods between the latest published
guideline and healthcare practice in our field. Surveys carried out on patients seem to suggest that both antiemetic therapies have similar effectiveness in clinical practice. The inclusion of NEPAd has led to a reduction in costs, positioning itself as an efficient option.