A cost-utility analysis of risk model-guided versus physician’s choice antiemetic prophylaxis in patients receiving chemotherapy for early-stage breast cancer: a net benefit regression approach

Kednapa Thavorn, Doug Coyle, Jeffrey S Hoch, Lisa Vandermeer, Sasha Mazzarello, Zhou Wang, George Dranitsaris, Dean Fergusson, Mark Clemons

Research output: Contribution to journalArticle

3 Scopus citations


Purpose: We assessed the cost-effectiveness of a risk model-guided (RMG) antiemetic prophylaxis strategy compared with the physician’s choice (PC) strategy in patients receiving chemotherapy for early-stage breast cancer. Methods: We conducted a cost-utility analysis based on a published randomized controlled trial of 324 patients with early-stage breast cancer undergoing chemotherapy at two Canadian cancer centers. Patients were randomized to receive their antiemetic treatments according to either predefined risk scores or the treating physician’s preference. Effectiveness was measured as quality-adjusted life years (QALYs) gained. Cost and utility data were obtained from the Canadian published literature. We used generalized estimating equations to estimate the incremental cost-effectiveness ratios (ICERs) and 95% confidence intervals (CIs) over a range of willingness-to-pay values. The lower and upper bounds of the 95% CIs were used to characterize the statistical uncertainty for the cost-effectiveness estimates and construct cost-effectiveness acceptability curves. Results: From the health care system’s perspective, the RMG strategy was associated with greater QALYs gained (0.0016, 95% CI 0.0009, 0.0022) and higher cost ($49.19, 95% CI $24.87, $73.08) than the PC strategy, resulting in an ICER of $30,864.28 (95% CI $14,718.98, $62,789.04). At the commonly used threshold of $50,000/QALY, the probability that RMG prophylaxis is cost-effective was >94%; this probability increased with greater willingness-to-pay values. Conclusion: The risk-guided antiemetic prophylaxis is an economically attractive option for patients receiving chemotherapy for early-stage breast cancer. This information supports the implementation of risk prediction models to guide chemotherapy-induced nausea and vomiting prophylaxis in clinical practices.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalSupportive Care in Cancer
StateAccepted/In press - Mar 9 2017



  • Chemotherapy-induced nausea and vomiting
  • Early stage breast cancer
  • Economic evaluation
  • Net-benefit regression approach
  • Risk model-guided antiemetic prophylaxis strategy

ASJC Scopus subject areas

  • Oncology

Cite this