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Evidence-based Practice and Quality Improvement

Cost-effectiveness of different combinations of ondansetron and dexamethasone in postoperative nausea and vomiting profilaxis

1AP1-7

Marco, G.; Gabarrell, M. A.; Pueyo, F. J.; López-Olaondo, L.; Sánchez-Ledesma, M. J.; Villalba, P.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 9-9
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Background and Goal of Study: In a public based health system, the rational use of economic resources is mandatory. In addition to that, the XXI Century Ethic Code includes in one of its articles, that the excellence of medical attention involves the rationalization of economic resources.

The aim of this study was to compare the cost-effectiveness relationship of three different associations of iv Ondansetron and Dexamethasone, in the prevention of postoperative nausea and vomiting (PONV) after Laparoscopic Colecistectomy (LC).

Materials and Methods: Clinical controlled trial (prospective, randomized, double blind and without group placebo). Local Ethics and Clinical Investigation Committee approval and informed consent in all cases.

74 ASA I-III women, between 22 and 72 years old and schedulled for LC were included in the study.

General balanced anaesthesia and postoperative analgesia with iv Paracetamol +Tramadol in all patients. Patients were randomized in three prevention PONV groups: GpA (Ondansetron 4mg+Dexamethasone 8mg), GpB (Ondansetron 4mg+Dexamethasone 4mg) and GpC (Ondansetron 2mg+Dexamethasone 8mg). PONV rescue with iv Dehidrobenzoperidol 0,625mg in all groups.

To analyze the results, we divided each group in three mutually excluding subgroups depending on PONV, nurse attention and rescue treatment needs. Direct cost and probabilities for each subgroup were calculated, and with those results we performed a hospital cost-effectiveness analysis (CI 95%)*.

Results and Discussion: The three selected drug combinations showed similar effectiveness in the prevention of PONV in LC although with different economical costs, being GpC (4,20 euros) the most economic option.

We also calculated the cost increment for each group in order to obtain a new patient with No NVPO when compared to GpC: Cost was then for GpA (+11,39 euros) and for GpB (+172 euros).

Conclusion(s): Ondansetron 2mg+Dexamethasone 8mg was the cheapest of the studied profilactic alternatives, and it also showed itself as the more economic option when focusing in the prevention of PONV in LC.

References: (*) BJA 2002; 91 (4):589-92.

© 2013 European Society of Anaesthesiology