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Olanzapine cost-effectiveness in vomiting and nausea from highly emetogenic chemotherapy in children and adolescents
  1. Manraj Singh Sra,
  2. Shuvadeep Ganguly,
  3. Ramavath Devendra Naik,
  4. Archana Sasi,
  5. Priya Sharma,
  6. Rupak Kumar Giri,
  7. Azgar Abdul Rasheed and
  8. Sameer Bakhshi
  1. Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Sameer Bakhshi, Medical Oncology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India; sambakh{at}


Objectives To assess the cost-effectiveness of addition of olanzapine to a prophylactic antiemetic regimen containing aprepitant, dexamethasone and ondansetron among children receiving highly emetogenic chemotherapy (HEC) in India, Bangladesh, Indonesia, the UK and the USA.

Methods Health states were estimated using individual patient-level outcome data from a randomised trial. The incremental cost–utility ratio (ICUR), incremental cost-effectiveness ratio and net monetary benefit (NMB) were calculated from the patient perspective for India, Bangladesh, Indonesia, the UK and the USA. One-way sensitivity analysis was done by varying the cost of olanzapine, cost of hospitalisation and utility values by ±25%.

Results The olanzapine arm had an increment of 0.0018 quality-adjusted life-years (QALY) over the control arm. The mean total expenditure in the olanzapine arm was greater by US$0.51, US$0.43, US$6.73, US$11.05 and US$12.35 in India, Bangladesh, Indonesia, the UK and the USA, respectively. The ICUR($/QALY) was US$282.60 in India, US$241.42 in Bangladesh, US$3755.93 in Indonesia, US$6161.83 in the UK and US$6887.41 in the USA. The NMB was US$9.86, US$10.12, US$14.08, US$44.74 and US$98.79 for India, Bangladesh, Indonesia, the UK and the USA, respectively. The ICUR estimates of the base case and sensitivity analysis were below the willingness-to-pay threshold in all scenarios.

Conclusion The addition of olanzapine as a fourth agent for antiemetic prophylaxis is cost-effective despite an increase in overall expenditure. Olanzapine should be uniformly considered for children receiving HEC.

  • Paediatrics
  • Supportive care
  • Nausea and vomiting

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  • MSS and SG contributed equally.

  • Contributors MSS, SG, AS, RKG, AAR and SB conceptualised and designed the study. MSS, RDN, PS and SB conducted data collection. MSS and SG conducted the analysis and wrote the manuscript. All authors edited and approved the final version of the manuscript. SB is the guarantor of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.