January 1997

The dos-response relation and cost-effectiveness of granisetron for the prophylaxis of pediatric postoperative emesis.

Cieslak GD, Watcha MF, Phillips MB, Pennant JH

Anesthesiology 1996: 85:1076-1085.

[ no abstract available ]

In this placebo controlled, double blind study, 97 children were randomized to placebo, 10 or 40 mcg/kg granisetron IV during routine anesthesia. Patients were divided into nine subgroups depending on the incidence of postoperative nausea and vomiting, the need for rescue therapy, and the side effects of the antiemetics. Granisetron 40 mcg/kg was effective in reducing the incidence and frequency of emesis and also shortened time to discharge readiness.

Administration of that dose of granisetron to all high risk patients would cost the ambulatory care center and additional $99 (95% CI, range $89-$112) per emesis free patient if nursing costs were excluded and $101 (95% CI, range $91-$113) if nursing costs are included.

This is another in a series of studies proving that this class of antiemetics is effective but expensive. Unfortunately the value of patient comfort is difficult to quantitate and no one wants to pay for it. Interestingly the incidence of vomiting after discharge which has no inherent cost was reduced to 9% compared to 42% for placebo and 36% for the granisetron 10 mcg/kg group.

I would suggest that somehow we need to place a value on patient comfort not just on hospital costs, particularly if we can completely eliminate postoperative nausea and vomiting. I certainly would have liked to have the benefit of this class of drugs when I had my surgical procedure!