Cost-effectiveness of prophylactic dolasetron or droperidol vs rescue therapy in the prevention of PONV in ambulatory gynecologic surgery

Purpose: To assess the cost-effectiveness of prophylactic therapy (1.25 mg droperidol or 50 mg dolasetron iv) vs no prophylaxis (rescue therapy) for the prevention of post-operative nausea and vomiting (PONV) from a Canadian hospital perspective, Methods: Design: A predictive decision analytic model using previously published clinical and economic evaluations, and costs of medical care in Canada. Subjects: Ambulatory gynecology surgery patients, interventions: Three strategies administered prior to emergence from anesthesia were compared: 1.25 mg droperidol iv, 50 mg dolasetron iv; and no prophylaxis (res; cue therapy). Results: The base case mean cost per patient receiving dolasetron prophylaxis was $28.08 CAN compared with $26.88 CAN per patient receiving droperidol prophylaxis, resulting in a marginal cost of $1.20 CAN. This difference translated in an additional cost of $12.00 CAN for the dolasetron strategy pr adverse event avoided over the droperidol strategy. The base case mean cost per patient not receiving prophylaxis was $26.92 resulting in marginal costs of $1.16 CAN and $0.04 CAN when compared to dolasetron and droperidol, respectively. Compared with the no prophylaxis strategy, dolasetron prophylaxis resulted in an incremental cost-effectiveness ratio of $5.82 CAN per additional PONV-free patient. The mean costs incurred per PONV-free patient were calculated to be $48.41 for the dolasetron strategy $46.34 for the droperidol strategy and $70.83 for the no prophylaxis strategy. Conclusions: Dolasetron and droperidol given intraoperatively were more cost-effective than no prophylaxis for PONV in patients undergoing ambulatory gynecologic surgery. The difference between the two agents was small and favoured droperidol, The model was robust to plausible changes through sensitivity analyses.