肿瘤化疗过程中3种止吐药物应用的成本-效果分析

目的 对恩丹西酮、格拉司琼与胃复安3种止吐药物进行回顾性研究，寻求最佳的治疗方案。方法 运用药物经济学的成本-效果分析方法。结果 以0度有效率为基准点，进行成本-效果分析。恩丹西酮组成本为186.24元，0度有效率为70.63%，成本效果比为2.64；格拉司琼组成本为228.21元，0度有效率为62.62%，成本效果比为3.64；胃复安组成本为23.01元，0度有效率为37.88%，成本效果比为0.61。结论 恩丹西酮组是3组当中最佳的治疗方案。     

格拉司琼与恩丹西酮预防化疗后恶性、呕吐的成本—效果分析

目的：比较格拉司琼与恩丹西酮预防化疗后恶心呕吐的疗效、不良反应及成本－效果。方法：以相关疗效指标及药物经济学成本－效果分析法进行评价，观察药物不良反应。结果：格拉司琼预防化疗后恶心、呕吐的有效率分别为83．6％和86．8％，每化疗周期人均费用为210．48元，成本－效果比分别为251．77和242．37；恩丹西酮的有效率分别为72．9％和83．7％，每化疗周期人均费用为381．35元，成本－效果比分别为523．11和456．62。两组患均未发现不良反应。结论：格拉司酮能有效地预防化疗后的恶性、呕吐，成本－效果比优于恩丹西酮。     

格拉司琼与恩丹西酮预防化疗后恶心、呕吐的成本-效果分析

目的比较格拉司琼与恩丹西酮预防化疗后恶心呕吐的疗效、不良反应及成本-效果.方法以相关疗效指标及药物经济学成本-效果分析法进行评价,观察药物不良反应.结果格拉司琼预防化疗后恶心、呕吐的有效率分别为83.6%和86.8%,每化疗周期人均费用为210.48元,成本-效果比分别为251.77和242.37;恩丹西酮的有效率分别为72.9%和83.7%,每化疗周期人均费用为381.35元,成本-效果比分别为523.11和456.62.两组患者均未发现不良反应.结论格拉司琼能有效地预防化疗后的恶心、呕吐,成本-效果比优于恩丹西酮.     

格拉司琼与恩丹西酮预防化疗致胃肠道反应临床对比研究

目的　比较格拉司琼与恩丹西酮预防化疗所致恶心呕吐的疗效和不良反应。方法　采用随机自身对照方法 ,将 2 4例接受联合化疗的患者随机分为A、B两组 ,均接受 2个周期相同方案的化疗。A组第 1周期使用格拉司琼 ,第 2周期使用恩丹西酮止吐 ;B组第 1周期用恩丹西酮 ,第 2周期使用格拉司琼止吐。结果　格拉司琼与恩丹西酮止吐作用有效率分别为 83 .3 %和 75 .0 % ,止恶心有效率分别为62 .5 %和 5 4.2 % ,经统计学处理两组差异无显著性 (P >0 .0 5 )。结论　格拉司琼和恩丹西酮均为预防化疗所致恶心呕吐的有效药物 ,不良反应轻微     

格拉司琼与恩丹西酮预防化疗后恶心、呕吐的成本-效果分析

目的 :比较格拉司琼与恩丹西酮预防化疗后恶心呕吐的疗效、不良反应及成本 -效果。方法 :以相关疗效指标及药物经济学成本 -效果分析法进行评价 ,观察药物不良反应。结果 :格拉司琼预防化疗后恶心、呕吐的有效率分别为83 6 %和86 8 %,每化疗周期人均费用为210 48元 ,成本 -效果比分别为251 77和242 37 ;恩丹西酮的有效率分别为72 9 %和83 7 %,每化疗周期人均费用为381 35元 ,成本 -效果比分别为523 11和456 62。两组患者均未发现不良反应。结论 :格拉司琼能有效地预防化疗后的恶心、呕吐 ,成本 -效果比优于恩丹西酮。     

恩丹西酮地塞米松防治化疗呕吐

目的 观察恩丹西酮、地塞米松联合与盐酸格拉司琼防治恶性肿瘤化疗所致呕吐的疗效及不良反应。方法 对124例接受以DDP联合化疗的恶性肿瘤患者,采用随机对比的方法,取64例用恩丹西酮联合地塞米松,另60例用格拉司琼治疗。结果 恩丹西酮、地塞米松联合组总有效率为97％,格拉司琼组总有效率为95％。结论 恩丹西酮、地塞米松联合是一种疗效高、价格低廉、安全有效的止吐方法。     

两种预防和治疗顺铂化疗所致呕吐的药物经济学评价

目的比较格拉司琼和恩丹西酮治疗化疗所致呕吐的经济效果。方法对40例接受顺铂化疗的患者,采用随机自身对照的方法,比较国产格拉司琼与恩丹西酮治疗化疗所致呕吐的止吐效果和毒性,并进行费用-效果分析。结果格拉司琼能有效预防顺铂所致恶心、呕吐,其止吐结果与恩丹西酮相似。两药防治恶心平均有效率分别为80.0%和78.3%;两药止吐平均有效率分别为84.2%和77.5%,疗效无统计学差异,毒副作用小。格拉司琼费用-效果比恩丹西酮优。结论盐酸格拉司琼为肿瘤化疗安全、有效、经济的止吐药物之一,值得推广应用。     

格拉司琼预防肿瘤化疗所致消化道反应的疗效观察

目的:探讨格拉司琼预防化疗所致消化道反应的临床效果及毒副反应。方法68例恶性肿瘤患者,采用随机分组分为A组(治疗组)和B组(对照组)。A组化疗当天及第2～5天每日静滴格拉司琼3mg∕次,B组化疗当天及第2～5天每日静滴恩丹西酮8mg次。结果用格拉司琼后在化疗第1～5天无恶心或轻度恶心的患者在82.4%～94.1%,用恩丹西酮后在化疗第1～5天无恶心或轻度恶心的患者在82.4%～91.2%。结论格拉司琼对减轻化疗药物所致的恶心反应以及对控制呕吐疗效与恩丹西酮相当,且副作用小,是一种安全有效价廉的止呕药。     

格拉司琼与恩丹西酮预防顺铂所致呕吐的疗效及费用-效果分析

目的 :了解格拉司琼与恩丹西酮的费用 -效果比。方法 :对36例接受顺铂化疗的患者 ,采用随机自身对照的方法 ,比较国产格拉司琼与恩丹西酮的止吐效果和毒性 ,并进行费用 -效果分析。结果 :格拉司琼能有效预防顺铂所致的恶心、呕吐 ,其止吐效果与恩丹西酮相似。两药防治恶心平均有效率分别为75 9 %和77 8 % ;两药止吐平均有效率分别为79 7 %和75 0% ,疗效无统计学差异 ,毒副作用小。格拉司琼费用 -效果比优于恩丹西酮。结论 :盐酸格拉司琼为肿瘤化疗安全、有效、经济的止吐药物之一 ,值得推广应用。     

格拉司琼和恩丹西酮预防顺铂所致消化道反应的随机对照研究

目的 观察并比较格拉司琼与恩丹西酮在预防顺铂所致的消化道反应的疗效和毒性反应。方法 采用随机自身前后对照试验设计，将37例接受顺铂联合化疗的肺癌患者，分为AB和BA两组，AB组第1周期用A方案（盐酸格位司琼3mg静注）每日1次，连用5d，第2周期用B方案（盐酸恩丹西酮8mg静注）每12h 1次，连用5d;BA组第1周期用B方案，第2周期用A方案，前后两周期化疗方案完全相同。结果 A，B方案均有良好的止吐疗效，在呕吐控制率，平均呕吐次数，恶心控制率及食欲影响方面两方案无统计学差异（P＞0．05）。两方案毒副反应均较小，可以耐受。结论 格拉司琼与恩丹西酮预防顺铂所致的消化道反应均有较好的疗效，毒副反应低。格拉司琼价格较低廉，更适合临床应用。     

Granisetron. A pharmacoeconomic evaluation of its use in the prophylaxis of chemotherapy-induced nausea and vomiting

The efficacy of granisetron in preventing acute nausea and vomiting during the 24 hours following chemotherapy in patients with cancer is equivalent to that of other serotonin 5-HT3 receptor antagonists (ondansetron and tropisetron) and similar to or greater than that of conventional antiemetic regimens such as metoclopramide plus dexamethasone. Like other 5-HT3 receptor antagonists, granisetron is generally well tolerated by most patients and its antiemetic efficacy is enhanced when used concomitantly with dexamethasone. To date, pharmacoeconomic evaluations of granisetron have involved intravenous administration of the drug to adult patients with cancer receiving single-dose or fractionated chemotherapy of moderate to high emetogenic potential. In economic analyses conducted in France, a single dose of granisetron 3mg was associated with a mean direct treatment cost per patient (or per well-controlled patient) approximately 50% lower than that for ondansetron 8mg intravenously followed by 8mg orally every 8 hours for 3 days, in patients receiving single-dose chemotherapy. Direct costs per patient were approximately 20 to 30% lower with granisetron (usually 3 mg/day) than ondansetron (usually 24 to 32 mg/day intravenously) in patients receiving chemotherapy fractionated over several days. Sensitivity analysis showed that the results, were robust to variations in the acquisition costs of the antiemetics. Granisetron also remained more cost effective than ondansetron with variations in the antiemetic dosage regimens, except when the granisetron dosage remained unchanged while the ondansetron dosage was reduced to a single 8mg intravenous dose on each day prior to chemotherapy (and no change in efficacy was assumed). Other economic evaluations suggest that granisetron may be more cost effective than a combined antiemetic regimen of high dose metoclopramide plus dexamethasone, and selected use of granisetron or ondansetron in patients receiving emetogenic chemotherapy can be implemented with relatively small incremental increases to the total cancer treatment budget, albeit with a marked increase in antiemetic acquisition costs. In conclusion, granisetron is an effective and well tolerated agent for the prophylaxis of acute chemotherapy-induced nausea and vomiting, and its selective use in this clinical setting can provide cost-effective antiemetic therapy.     

Antiemetic effectiveness of ondansetron and granisetron in patients with breast cancer treated with cyclophosphamide.

PURPOSE: The antiemetic effectiveness of ondansetron 8 mg i.v, ondansetron 32 mg i.v, and granisetron 10 microg/kg or 1 mg i.v. as prophylaxis in breast cancer patients regimens was studied. METHODS: Data from six U.S. cancer centers were collected retrospectively for 224 patients who received cyclophosphamide-containing therapy between January 1998 and June 2002. Logistic-regression analysis was used to examine the likelihood of chemotherapy-induced nausea and vomiting (CINV) both on an unadjusted basis and controlling for concomitant radiation therapy and dexamethasone use. RESULTS: Seventy-six patients (34%) received ondansetron 32 mg, 68 (30%) received ondansetron 8 mg, and 80 (36%) received granisetron (either 10 microg/kg or 1 mg). Patients receiving ondansetron 8 mg were 2.5 times as likely to have CINV on an adjusted basis as granisetron recipients (p < 0.01). There was no increase in the risk of CINV with ondansetron 32 mg compared with granisetron. Patients treated with ondansetron 8 mg required more rescue antiemetics and more prophylactic antiemetics in subsequent chemotherapy cycles than patients in the other groups. CONCLUSION: In a retrospective multicenter study, granisetron 1 mg or 10 microg/kg and ondansetron 32 mg appeared more effective than ondansetron 8 mg in preventing acute CINV related to cyclophosphamide therapy.     

5种方案治疗卵巢癌化疗所致呕吐的成本-效果分析

目的：比较5种止吐方案对预防卵巢癌化疗所致呕吐的药物经济学分析。方法：对200例接受化疗的卵巢癌患者分为5组,分别用阿扎司琼氯化钠注射液（A组）、盐酸昂丹司琼（B组）、托烷司琼氯化钠注射液（C组）、雷莫司琼（D组）、格拉司琼氯化钠注射液（E组）预防化疗所致呕吐,观察其疗效并进行成本-效果分析。结果：5组止吐有效率分别为90%、95%、95%、90%、85%,成本-效果比分别为7.08、6.88、6.89、2.64、3.12、;以E组为参照,A、B、C、D组的增量成本-效果比分别为74.4、38.9、39.0、-5.4。结论：D组是预防化疗所致呕吐方案中较为合理的方案。     

The utility of antiemetics in the prevention and treatment of postoperative nausea and vomiting in patients scheduled for laparoscopic cholecystectomy

Postoperative nausea and vomiting (PONV) are distressing and frequent adverse events of anesthesia and surgery, with a relatively high incidence after laparoscopic cholecystectomy. Numerous antiemetics have been studied for the prevention and treatment of PONV in patients scheduled for laparoscopic cholecystectomy. Traditional antiemetics, including anticholinergics (e.g., scopolamine), antihistamines (e.g., dimenhydrinate), phenothiazines (e.g., promethazine), butyrophenones (e.g., droperidol), and benzamide (e.g., metoclopramide), are used for the control of PONV. The available nontraditional antiemetics for the prophylaxis against PONV are dexamethasone and propofol. Serotonin receptor antagonists (ondansetron, granisetron, tropisetron, dolasetron, and ramosetron), compared with traditional antiemetics, are highly efficacious for PONV. The prophylactic ondansetron, granisetron, tropisetron, and dolasetron in antiemetic efficacy are comparable. Ramosetron is effective for the long-term prevention of PONV. None of the available antiemetics is entirely effective, perhaps because most of them act through the blockade on one type of receptor. There is a possibility that combined antiemetics with different sites of activity would be more effective than one drug alone for the prophylaxis against PONV. Combination antiemetic therapy is often effective for the prevention of PONV following laparoscopic cholecystectomy. The efficacy of a combination of serotonin receptor antagonists (ondansetron and granisetron) and droperidol is superior to monotherapy with a serotonin receptor antagonist or droperidol. Similarly, adding dexamethasone to ondansetron or granisetron improves antiemetic efficacy in PONV. Knowledge regarding antiemetics is necessary to completely prevent and treatment of PONV in patients scheduled for laparoscopic cholecystectomy.     

Diverging effects of 5-HT3 receptor antagonists ondansetron and granisetron on estramustine-inhibited cellular potassium transport

We used 86Rb+ (K+ analogue) to study potassium influx during the interaction of highly specific 5-HT3-receptor antagonists, ondansetron and granisetron, with the effects of the anticancer drug, estramustine phosphate, on P31 mesothelioma cells. Estramustine phosphate (80 mg/l, 142 micromol/l) for 120 min. reduced 86Rb+ influx by 18.7%. The reduction was inhibited by ondansetron (0.1 micromol/l), but augmented by granisetron (0.1 micromol/l). Serotonin (1.0 micromol/l) antagonized ondansetron inhibition and restored granisetron-augmented reduction of estramustine phosphate-induced 86Rb+ influx to the level of the drug itself. Estramustine phosphate inhibited cellular Na+, K+, 2Cl- -cotransport activity whereas Na+, K+, ATPase activity was unaffected. Ondansetron blockade of estramustine phosphate-induced reduction of 86Rb+ influx was due to increased Na+, K+, ATPase and Na+, K+, 2Cl- -cotransport whereas augmentation of estramustine phosphate-induced reduction of 86Rb+ influx by granisetron, or combination of 5-HT3 receptor antagonists with serotonin was due mainly to inhibition of cellular Na+, K+, ATPase activity Thus, ondansetron possesses a distinct ability to reverse K+ influx of tumour cells exposed to estramustine phosphate whereas granisetron does not, due to different effect on cellular Na+, K+, ATPase and Na+, K+, 2Cl- -cotransport activity. Highly 5-HT3 receptor-specific antiemetic agents may have different effects on ion transport of tumour cells during treatment with cytotoxic drugs.     

昂丹司琼、格拉司琼和帕洛诺司琼预防食管癌术后化疗所致恶心、呕吐的效果观察

目的 比较昂丹司琼、格拉司琼和帕洛诺司琼预防食管癌术后化疗所致恶心、呕吐的临床效果及安全性.方法 将60例食管癌术后患者随机分为昂丹司琼组、格拉司琼组和帕洛诺司琼组,各20例,均行顺铂等药物化疗,并分别给予昂丹司琼、格拉司琼和帕洛诺司琼预防恶心、呕吐反应;观察3组患者恶心、呕吐的控制效果及不良反应.结果 昂丹司琼组、格拉司琼组和帕洛诺司琼组患者恶心、呕吐控制急性期有效率分别为55％、60％、75％,帕洛诺司琼组与其他两组比较,差异有统计学意义（P＜0.05）;延迟期有效率分别为40％、45％、75％,帕洛诺司琼组与其他两组比较,差异有统计学意义（P＜0.05）.结论 帕洛诺司琼预防化疗所致恶心、呕吐效果较昂丹司琼、格拉司琼更优,安全性相似,且临床应用方便.     

Randomized, multicenter comparison of oral granisetron and oral ondansetron for emetogenic chemotherapy

Study Objectives. To compare the antiemetic effectiveness and safety of oral granisetron plus dexamethasone with those of oral ondansetron plus dexamethasone administered before emetogenic chemotherapy. Design. Randomized, prospective, multicenter, open-label study. Settings. University-teaching hospital and veterans health care system. Patients. Sixty-one chemotherapy-naïve patients scheduled to receive emetogenic antineoplastic agents. Intervention. A single-dose oral granisetron 1 mg and dexamethasone 12 mg or single-dose oral ondansetron 16 mg and dexamethasone 12 mg was administered before chemotherapy. Measurements and Results. Twenty-four hours after administration patients were contacted to assess nausea, emesis, and adverse events. There were no statistical differences in frequency of nausea or emesis between groups. Seventy-six percent and 82% of patients receiving ondansetron and granisetron, respectively, experienced no emesis 24 hours after chemotherapy. Complete protection from nausea occurred in 58% and 46% of patients receiving the drugs, respectively. Adverse events were similar between groups. Conclusion. Oral granisetron 1 mg and ondansetron 16 mg plus dexamethasone are safe and effective in preventing nausea and vomiting related to emetogenic chemotherapy.     

Cost-effectiveness analysis of ondansetron and prochlorperazine for the prevention of postoperative nausea and vomiting

OBJECTIVE: To compare the cost-effectiveness of 2 antiemetic agents, ondansetron and prochlorperazine, for the prevention of postoperative nausea and vomiting (PONV) in patients undergoing total hip replacement or total knee replacement procedures. METHODS: The cost-effectiveness analysis model was applied to data derived from a previous clinical study conducted in 1995 and 1996. This study involved 78 adult patients (62.8% female and 37.2% male) undergoing total hip replacement or total knee replacement procedures. Patients were enrolled in a randomized, double-blind manner to receive either ondansetron 4 mg intrvenously (n=37) or prochlorperazine 10 mg intramuscularly (n=41) immediately upon completion of surgery and were monitored for occurrences of PONV during the subsequent 48 hours. In our analysis, we measured the cost-effectiveness ratio (C/E ratio), defined as the cost per successfully treated patient, for each antiemetic agent using the clinical data obtained from the previous study. RESULTS: The incidence of PONV and use of rescue antiemetics was significantly greater in the ondansetron group compared with the prochlorperazine group. The mean total costs of PONV management per patient in the prochlorperazine and ondansetron groups were dollar 13.99 and dollar 51.98, respectively (based on 2004 average wholesale prices [AWP]). The cost of successfully treating one patient with prochlorperazine and ondansetron was dollar 31.87 and dollar 275.01, respectively. One-way sensitivity analysis was performed adjusting the percent efficacy rate of each antiemetic and the drug cost of ondansetron (up to a 50% reduction in AWP). Prochlorperazine remained the dominant strategy across each scenario. CONCLUSION: The results indicate that prochlorperazine is a more cost-effective antiemetic compared with ondansetron for the prevention of PONV in a mixed gender, adult inpatient population undergoing total joint arthroplasty.