International journal of clinical oncology · 2026
Clinical benefit and economic value of fosnetupitant versus aprepitant in carboplatin-Based chemotherapy: a real-world study.
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Inano Hiroshi, Morimoto Yoshihito, Kawamura Atsushi, Ikegami Taichi, Niizuma Tomoki, Kitagawa Kanata, Usami Rie, Nakagomi Kozue, Shono Aiko, Watanabe Kazuhiro, Otori Katsuya
Аннотация
BACKGROUND: Fosnetupitant (F-NTP) has demonstrated superior antiemetic efficacy compared with aprepitant in carboplatin-based chemotherapy in real-world settings. However, whether this clinical benefit translates into economic value remains unclear. We evaluated the cost-effectiveness of F-NTP compared with aprepitant and examined the impact of incorporating productivity loss from a societal perspective.
METHODS: A real-world three-phase decision-analytic model with a 7-day time horizon was constructed to estimate quality-adjusted life years (QALYs) based on chemotherapy-induced nausea and vomiting health states. Economic outcomes were assessed from a payer perspective using a willingness-to-pay (WTP) threshold of 5 million JPY per QALY, followed by a societal scenario that included productivity loss. Deterministic and probabilistic sensitivity analyses were performed to evaluate the parameter uncertainty.
RESULTS: From the payer perspective, F-NTP provided greater QALY gains than aprepitant but at a higher cost, resulting in an incremental cost-effectiveness ratio (ICER) of JPY 13,374,496/QALY, which exceeded the prespecified WTP threshold of JPY 5 million/QALY. The inclusion of productivity loss reduced the ICER to JPY 12,413,622/QALY and modestly increased the probability of F-NTP being cost-effective. However, aprepitant remained the preferred strategy at the prespecified WTP threshold.
CONCLUSION: At the prespecified WTP threshold of 5 million JPY/QALY, aprepitant was more likely to be cost-effective than F-NTP for carboplatin-based chemotherapy. Incorporating productivity loss reduced the ICER for F-NTP and modestly increased its probability of being cost-effective, although the overall conclusion regarding cost-effectiveness remained unchanged.
METHODS: A real-world three-phase decision-analytic model with a 7-day time horizon was constructed to estimate quality-adjusted life years (QALYs) based on chemotherapy-induced nausea and vomiting health states. Economic outcomes were assessed from a payer perspective using a willingness-to-pay (WTP) threshold of 5 million JPY per QALY, followed by a societal scenario that included productivity loss. Deterministic and probabilistic sensitivity analyses were performed to evaluate the parameter uncertainty.
RESULTS: From the payer perspective, F-NTP provided greater QALY gains than aprepitant but at a higher cost, resulting in an incremental cost-effectiveness ratio (ICER) of JPY 13,374,496/QALY, which exceeded the prespecified WTP threshold of JPY 5 million/QALY. The inclusion of productivity loss reduced the ICER to JPY 12,413,622/QALY and modestly increased the probability of F-NTP being cost-effective. However, aprepitant remained the preferred strategy at the prespecified WTP threshold.
CONCLUSION: At the prespecified WTP threshold of 5 million JPY/QALY, aprepitant was more likely to be cost-effective than F-NTP for carboplatin-based chemotherapy. Incorporating productivity loss reduced the ICER for F-NTP and modestly increased its probability of being cost-effective, although the overall conclusion regarding cost-effectiveness remained unchanged.