Yeh, Y.C., McDonnell, A., Klinger, E., Fowler, B., Matta, L., Voit, D., & Reddy, P. (2011). Comparison of healthcare resource use between patients receiving ondansetron or palonosetron as prophylaxis for chemotherapy-induced nausea and vomiting. Journal of Oncology Pharmacy Practice, 17(3), 179–185.

To analyze the differences between ondansetron and palonosetron in healthcare resource use (i.e., inpatient/outpatient encounters) among patients receiving intraperitoneal (IP) cisplatin

This study reported on a review of an electronic medical record system. Key variables were patient characteristics, chemotherapy regimen, diagnosis, medications, type of 5-HT₃ receptor antagonist (RA), other healthcare resource use, and reasons for use.

• The study reported on 48 patients; however, analysis was based on each IP administration.
• Mean age was 59 years.
• All patients were female.
• The most common cancer diagnosis was ovarian, followed by fallopian tube.
• All patients were receiving IP cisplatin as part of the GOG-172 regimen (six cycles: paclitaxel on day 1 as 24-hour IV infusion (135 mg/m² BSA), IP cisplatin on day 2 (100 mg/m² BSA), hydration on day 3 and discharge, and IP cisplatin (60 mg/m² BSA) on day 8 in the outpatient clinic). 
• Antiemetic coverage was 5-HT₃ RA plus aprepitant and dexamethasone on days 2–3, and aprepitant plus dexamethasone on day 4.
• For breakthrough CINV, prochlorperazine, metoclopramide, diphenhydramide, and lorazepam were prescribed. Patients received dexamethsone on day 1 for fluid retention purposes (not for the control of CINV).

This was a single-site, inpatient and outpatient study conducted in Massachusetts.

• Patients were undergoing the active treatment phase of care.
• The study has clinical applicability for late effects and survivorship.

This was an observational study (electronic chart review).

The following were recorded.

• CINV-related hospital readmission occurrence    
• Emergency department visits
• Outpatient encounters (clinic visits, telephone calls) occurring within 7 days after cisplatin administration
• CINV-related resource use: events associated with dehydration, hypovolemia, nausea/vomiting, hypokalemia, constipation, shortness of breath, syncope/collapse
   

More CINV-related hospitalizations were found with ondansetron versus palonosetron (5.1% vs. 0%, p = 0.09) with no significant difference in other CINV-related encounters. Palonosetron was always administered as single-day therapy; ondansetron was administered as one-day (27%) or multiday (73%) therapy. No significant differences were found in hospital readministrations, emergency department visits, outpatient visits, or switches to alternate 5-HT₃ RAs between palonosetron and ondansetron. When CINV-related resource use was compared, a trend to more hospitalization was noted in the ondansetron arm, although it was not significant (2 out of 39 in the ondansetron arm versus 0 out of 89 in the palonosetron arm).

Palonosetron was associated with a trend to a lower risk of CINV-related hospital readmission than ondansetron in patients receiving IP cisplatin for gynecological cancers; however, the trend was not statistically significant. The duration of ondansetron therapy might be suboptimal with 27% of patients receiving only one day of therapy during hospital stay.

• No appropriate control group was included.
• Three different data collection periods were used.
• Suboptimal antiemetic intervention was used on day 1 (only dexamethasone for fluid retention purpose).
• Medications taken on an as-need basis and after discharge were not tracked.
• Patients who used healthcare facilities not affiliated with the study institution were not captured.
• Healthcare resource use after 7 days of IP chemo was not assessed. 
• The sample size was small (the study should have had 79 cases in each 5-HT₃ RA arm; however, only 48 patients were included), and the unit of analysis was not each individual patient, but each IP chemotherapy administration.
• Risk factors for CINV were not considered.
• The methodological quality of this study is low.

Because of the design and limitations, this study does not help in building evidence for the conclusion that palonosetron has a lower risk of CINV-related readmission compared to ondansetron.