The dose-response relation and cost-effectiveness of granisetron for the prophylaxis of pediatric postoperative emesis

Gary D. Cieslak, Mehernoor F. Watcha, Michael B. Phillips, John H. Pennant

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: Postoperative nausea and vomiting (PONV) may delay discharge from hospital after ambulatory surgery. The antiserotonin agents, ondansetron and granisetron, provide effective prophylaxis against chemotherapy-induced and postoperative nausea and vomiting in adults, but are expensive. We determined the dose-response relation of granisetron and the financial impact of using this drug in preventing PONV after pediatric outpatient surgery. Methods: In a randomized, double-blind, placebo-controlled study, 97 pediatric outpatients received a placebo or 10 or 40 μg · kg -1 granisetron intravenously during a standardized anesthetic. Episodes of postoperative retching, vomiting, and times to discharge readiness were recorded. A decision analysis tree was used to divide each study group into nine mutually exclusive subgroups, depending on the incidence of PONV, need for rescue therapy, and the side effects of antiemetics. Costs and probabilities were assigned to each subgroup, and the cost-effectiveness ratio was determined by dividing the sum of these weighted costs by the number of patients free from both PONV and antiemetic side effects. Results: Granisetron (40 μg · kg -1 intravenously) was more effective than a placebo or 10 μg · kg -1 granisetron in decreasing the incidence and frequency of postoperative emesis, both in the ambulatory surgery center and during the first 24 h. Patients receiving 40 μg · kg -1 granisetron also had shorter times to discharge readiness compared with those receiving a placebo. Administering this dose of granisetron to all high-risk patients would cost the ambulatory care center an additional $99 (95% CI, range $89- $112) per emesis-free patient if nursing labor costs are excluded and $101 (95% CI, range $91-$113) if nursing costs are included. Conclusions: In this study, 40 μg · kg -1 intravenous granisetron (but not 10 μg · kg -1) provided effective prophylaxis in children against PONV compared with a placebo, but at a high cost. The effective dose of granisetron for PONV prophylaxis is higher than the Food and Drug Administration-recommended dose for chemotherapy-induced emesis.

Original languageEnglish (US)
Pages (from-to)1076-1085
Number of pages10
JournalAnesthesiology
Volume85
Issue number5
DOIs
StatePublished - 1996

Fingerprint

Granisetron
Postoperative Nausea and Vomiting
Cost-Benefit Analysis
Pediatrics
Costs and Cost Analysis
Placebos
Ambulatory Surgical Procedures
Antiemetics
Vomiting
Nursing
Drug Therapy
Ondansetron
Decision Trees
Decision Support Techniques
Incidence
United States Food and Drug Administration
Ambulatory Care
Anesthetics
Outpatients

Keywords

  • Anesthesia, ambulatory: pediatrics
  • Antiemetics: granisetron
  • Complications: postoperative vomiting
  • Economics: drugs

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The dose-response relation and cost-effectiveness of granisetron for the prophylaxis of pediatric postoperative emesis. / Cieslak, Gary D.; Watcha, Mehernoor F.; Phillips, Michael B.; Pennant, John H.

In: Anesthesiology, Vol. 85, No. 5, 1996, p. 1076-1085.

Research output: Contribution to journalArticle

Cieslak, Gary D. ; Watcha, Mehernoor F. ; Phillips, Michael B. ; Pennant, John H. / The dose-response relation and cost-effectiveness of granisetron for the prophylaxis of pediatric postoperative emesis. In: Anesthesiology. 1996 ; Vol. 85, No. 5. pp. 1076-1085.
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abstract = "Background: Postoperative nausea and vomiting (PONV) may delay discharge from hospital after ambulatory surgery. The antiserotonin agents, ondansetron and granisetron, provide effective prophylaxis against chemotherapy-induced and postoperative nausea and vomiting in adults, but are expensive. We determined the dose-response relation of granisetron and the financial impact of using this drug in preventing PONV after pediatric outpatient surgery. Methods: In a randomized, double-blind, placebo-controlled study, 97 pediatric outpatients received a placebo or 10 or 40 μg · kg -1 granisetron intravenously during a standardized anesthetic. Episodes of postoperative retching, vomiting, and times to discharge readiness were recorded. A decision analysis tree was used to divide each study group into nine mutually exclusive subgroups, depending on the incidence of PONV, need for rescue therapy, and the side effects of antiemetics. Costs and probabilities were assigned to each subgroup, and the cost-effectiveness ratio was determined by dividing the sum of these weighted costs by the number of patients free from both PONV and antiemetic side effects. Results: Granisetron (40 μg · kg -1 intravenously) was more effective than a placebo or 10 μg · kg -1 granisetron in decreasing the incidence and frequency of postoperative emesis, both in the ambulatory surgery center and during the first 24 h. Patients receiving 40 μg · kg -1 granisetron also had shorter times to discharge readiness compared with those receiving a placebo. Administering this dose of granisetron to all high-risk patients would cost the ambulatory care center an additional $99 (95{\%} CI, range $89- $112) per emesis-free patient if nursing labor costs are excluded and $101 (95{\%} CI, range $91-$113) if nursing costs are included. Conclusions: In this study, 40 μg · kg -1 intravenous granisetron (but not 10 μg · kg -1) provided effective prophylaxis in children against PONV compared with a placebo, but at a high cost. The effective dose of granisetron for PONV prophylaxis is higher than the Food and Drug Administration-recommended dose for chemotherapy-induced emesis.",
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AU - Phillips, Michael B.

AU - Pennant, John H.

PY - 1996

Y1 - 1996

N2 - Background: Postoperative nausea and vomiting (PONV) may delay discharge from hospital after ambulatory surgery. The antiserotonin agents, ondansetron and granisetron, provide effective prophylaxis against chemotherapy-induced and postoperative nausea and vomiting in adults, but are expensive. We determined the dose-response relation of granisetron and the financial impact of using this drug in preventing PONV after pediatric outpatient surgery. Methods: In a randomized, double-blind, placebo-controlled study, 97 pediatric outpatients received a placebo or 10 or 40 μg · kg -1 granisetron intravenously during a standardized anesthetic. Episodes of postoperative retching, vomiting, and times to discharge readiness were recorded. A decision analysis tree was used to divide each study group into nine mutually exclusive subgroups, depending on the incidence of PONV, need for rescue therapy, and the side effects of antiemetics. Costs and probabilities were assigned to each subgroup, and the cost-effectiveness ratio was determined by dividing the sum of these weighted costs by the number of patients free from both PONV and antiemetic side effects. Results: Granisetron (40 μg · kg -1 intravenously) was more effective than a placebo or 10 μg · kg -1 granisetron in decreasing the incidence and frequency of postoperative emesis, both in the ambulatory surgery center and during the first 24 h. Patients receiving 40 μg · kg -1 granisetron also had shorter times to discharge readiness compared with those receiving a placebo. Administering this dose of granisetron to all high-risk patients would cost the ambulatory care center an additional $99 (95% CI, range $89- $112) per emesis-free patient if nursing labor costs are excluded and $101 (95% CI, range $91-$113) if nursing costs are included. Conclusions: In this study, 40 μg · kg -1 intravenous granisetron (but not 10 μg · kg -1) provided effective prophylaxis in children against PONV compared with a placebo, but at a high cost. The effective dose of granisetron for PONV prophylaxis is higher than the Food and Drug Administration-recommended dose for chemotherapy-induced emesis.

AB - Background: Postoperative nausea and vomiting (PONV) may delay discharge from hospital after ambulatory surgery. The antiserotonin agents, ondansetron and granisetron, provide effective prophylaxis against chemotherapy-induced and postoperative nausea and vomiting in adults, but are expensive. We determined the dose-response relation of granisetron and the financial impact of using this drug in preventing PONV after pediatric outpatient surgery. Methods: In a randomized, double-blind, placebo-controlled study, 97 pediatric outpatients received a placebo or 10 or 40 μg · kg -1 granisetron intravenously during a standardized anesthetic. Episodes of postoperative retching, vomiting, and times to discharge readiness were recorded. A decision analysis tree was used to divide each study group into nine mutually exclusive subgroups, depending on the incidence of PONV, need for rescue therapy, and the side effects of antiemetics. Costs and probabilities were assigned to each subgroup, and the cost-effectiveness ratio was determined by dividing the sum of these weighted costs by the number of patients free from both PONV and antiemetic side effects. Results: Granisetron (40 μg · kg -1 intravenously) was more effective than a placebo or 10 μg · kg -1 granisetron in decreasing the incidence and frequency of postoperative emesis, both in the ambulatory surgery center and during the first 24 h. Patients receiving 40 μg · kg -1 granisetron also had shorter times to discharge readiness compared with those receiving a placebo. Administering this dose of granisetron to all high-risk patients would cost the ambulatory care center an additional $99 (95% CI, range $89- $112) per emesis-free patient if nursing labor costs are excluded and $101 (95% CI, range $91-$113) if nursing costs are included. Conclusions: In this study, 40 μg · kg -1 intravenous granisetron (but not 10 μg · kg -1) provided effective prophylaxis in children against PONV compared with a placebo, but at a high cost. The effective dose of granisetron for PONV prophylaxis is higher than the Food and Drug Administration-recommended dose for chemotherapy-induced emesis.

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KW - Economics: drugs

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