Nausea and vomiting are fairly common symptoms resulting in emergency room visits and in hospitalization. Some common medical conditions that result in these symptoms include “Gastroenteritis (food poisoning), pregnancy, complication of chemotherapy in cancer patients, and major surgical procedures” ((Cortina-Borja M, et al. (2010) Prenatal Treatment for Serious Neurological Sequelae of Congenital Toxoplasmosis: An Observational Prospective Cohort Study. Plos Med. Oct 12;(7)(10) )).
Ondansetron is the most effective anti-vomiting drug available today. It is available in both injectable and oral forms and is more efficient than any other available medications that treat nausea and vomiting ((Currow C. D, et al. (1997) Use of ondansetron in palliative medicine. J Pain Symptom Management. May; 13(5): 302-7 )).
Ondansetron was developed in the 1980’s by a scientist working for a leading pharmaceutical laboratory in London, and was finally approved in 1991 by the United States Food and Drug Administration (FDA) for use in adult patients ((Power et al. (1999) Journal Clinical Oncology. Jan;17(1):344-51)). Later, further research was done in pediatric patients and in 2006 the FDA approved the drug for children. The FDA recently has approved its generic form and since then the drug has been available from various pharmaceutical laboratories thus reducing its cost.
But why does this matter? What effect does this drug have on the medical world? Simply put, this revolutionary drug has proven again and again to be clinically beneficial. An increase in this treatment strategy should be able to drastically improve the medical world in the years to come.
Gastroenteritis is one of the most common infectious disease syndromes affecting humans. It is usually caused by viruses, the most common one being Rotavirus, and is usually associated with vomiting and diarrhea resulting in severe dehydration--which can be deadly, especially in infants and children. The most effective way of treating these patients requires prompt intervention with an anti-emetic, or anti-vomiting, medication and rehydration. Ondansetron has played a vital role in reducing morbidity and mortality in children afflicted with gastroenteritis as it has been shown to be more effective as compared to any of the other anti-emetic medications ((Piwko C, et al. (2005) Economic evaluation of ondansetron vs dimenhydrinate for prevention of postoperative vomiting in children undergoing strabismus surgery. Pediatric Anaesth. Sep; 15(9): 755-61)).
Cancer remains one of the most prevalent medical conditions. It is associated with a high morbidity and mortality. Prostate, lung and colon cancer are the three most prevalent cancers in men and breast and colon cancer remain the two most common in women. With the advancement in medicine, new drugs are being developed to treat various types of cancers. One common side effect of almost all chemotherapeutic drugs is nausea and vomiting2. Before the availability of Ondansetron, patients often required prolonged hospitalization to manage chemotherapy related nausea and vomiting. With the availability of Ondansetron in injectible and oral forms, physicians can often administer chemotherapy in the office4.
Many recent studies have shown that Ondansetron use has lead to savings of millions of health care dollars annually due to its effectiveness as an anti-nausea and anti-vomiting drug as well. In 1999, the cost effectiveness of Ondasetron use in cancer patients receiving chemotherapy was evaluated in the Journal of Clinical Oncology. The authors retrospectively assessed antiemetic costs. The “antiemetic costs” included drug costs, nursing, pharmacy and physician time, supplies and other costs related to patient care. The authors found a decrease in cost per patient per month of treatment of $374, which translates into millions of dollars of health care expenditure in the United States.
In 1997, the impact of a home chemotherapy program for pediatric oncology patients was studied. Researchers concluded that successful control of nausea and vomiting with the use of Ondansetron resulted in substantial monetary savings for health insurance plans by substantially reducing hospitalization due to adequate control of nausea and vomiting, which is one of the most common adverse side-effects of chemotherapy ((Holdsworth T. M, et al. (1997) Economic impact with home delivery of chemotherapy to pediatric oncology patients. Ann Pharmacother. Feb; 31(2): 140-8)).
Ondansetron has also been used effectively in palliative medicine2. Besides cost efficiency, the authors noted better symptom control as well.
Patients who have used this drug have shown significant improvement in nausea and vomiting in patients following surgery ((Zarate E, et al. (2000) A comparison of the costs and efficacy of ondansetron versus dolasetron for antiemetic prophylaxis. Anesth Analg. June;90(6):1352-8)). This resulted in a shortened stay in the recovery room following surgery and a shortened hospital stay as well.
More recently the efficacy of oral Ondansetron was studied in emergency departments administered to children with gastroenteritis. The researchers found that in the United States, the administration of oral Ondansetron to children with gastroenteritis prevents 29,246 intravenous insertions and 7,220 hospitalizations annually. This would result in an annual savings to the society of 65.6 million US dollars and health care payers 61.1 million dollars.
Cost analysis does not take into consideration the morbidity associated with severe nausea and vomiting. The introduction of Ondansetron has resulted in significant reduction in morbidity and a notable improvement in patient’s well being. Biomedical research is vital for optimizing health care delivery, but due to the continued financial crisis nationally and internationally, funding for research is being compromised. This will ultimately affect all of us, directly or indirectly.
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