While a lot of studies evaluated aprepitant and fosaprepitant, the research has focused primarily on post-operative nausea and vomiting (PONV) incidence, vomiting rates, rescue antiemetic use, and adverse events rather than healthcare utilization metrics. Evidence shows that aprepitant reduces nausea, vomiting, and rescue antiemetic requirements, with enhanced effects when combined with dexamethasone and ondansetron, and appears more effective at preventing vomiting than nausea. Fosaprepitant, particularly when added to standard prophylaxis in high-risk patients, lowers PONV incidence, emetic episodes, and rescue antiemetic use, though it may increase intraoperative hypotension. Network meta-analyses rank NK₁ receptor antagonists among the most effective single agents for vomiting prevention, with drug combinations generally showing greater efficacy. Overall, serious adverse events are uncommon, and safety profiles are favorable, but no studies reported outcomes such as cost-effectiveness, length of stay, or need for hospital admission. [1], [2], [3], [4]
A 2022 review evaluated the clinical and cost-effectiveness of aprepitant for preventing PONV in patients with refractory PONV or at risk of life-threatening complications from emesis. No studies were found assessing cost-effectiveness or guidelines for these populations, and clinical effectiveness evidence was limited to three studies in patients undergoing craniotomy or bariatric surgery. Evidence showed that aprepitant reduced post-operative vomiting compared with ondansetron but had little-to-no effect on nausea, and the combination of aprepitant and ondansetron may reduce the need for rescue antiemetics. Severity of PONV may be lower with aprepitant, while length of stay and overall quality of life were largely unchanged. Methodological limitations, variability in interventions and outcomes, and limited generalizability restrict the certainty of conclusions, highlighting a need for further research. [5]
Although these findings relate to chemotherapy-induced nausea and vomiting (CINV) and cannot be directly extrapolated to post-operative settings, a 2021 systematic review analyzed 13 studies on the cost-effectiveness of aprepitant for CINV prevention. The review found that adding aprepitant to a standard antiemetic regimen with a 5-HT3 receptor antagonist and dexamethasone was generally cost-effective. While medication costs increased initially, overall healthcare costs decreased due to lower rates of nausea, vomiting, and reduced need for additional interventions. Comparisons with other antiemetics suggested that aprepitant was often more cost-effective or offered similar economic value, though netupitant/palonosetron and olanzapine were sometimes more favorable depending on the context. [6]
A 2023 retrospective chart review evaluated the impact of fosaprepitant on perioperative antiemetic utilization, treatment cost, and patient satisfaction in patients undergoing bariatric surgery. This investigation involved 400 patients from the Orlando Health Medical Center, divided into two groups: one receiving the standard of care antiemetic regimen and the other administered fosaprepitant. The standard regimen included scopolamine, dexamethasone, ondansetron, and promethazine for preoperative prophylaxis, as well as ondansetron and promethazine postoperatively. In contrast, the fosaprepitant group received a 75 mg intravenous dose preoperatively, with the potential for an additional dose postoperatively. Use of fosaprepitant in place of a standard antiemetic regimen was associated with lower overall PONV-related medication and administration costs. Total medication costs decreased from approximately $46.47 to $25.69 per patient, with reductions observed across commonly used agents including ondansetron, promethazine, scopolamine, and dexamethasone. Administration-related costs were also lower in the fosaprepitant group. A subset of patients (12.5%) required an additional dose due to persistent symptoms. Patient satisfaction improved by 11.6% with fosaprepitant use. [7]
A 2024 investigation explored the efficacy of aprepitant (80 mg) in preventing PONV in patients undergoing laparoscopic sleeve gastrectomy. This retrospective chart review analyzed data from 354 patients at a community hospital who underwent the procedure between January 1, 2014, and December 31, 2017. Patients were divided into two groups: those receiving standard antiemetic prophylaxis and those receiving an additional 80 mg dose of aprepitant. The standard regimen included a scopolamine patch, IV dexamethasone, and IV ondansetron. The results demonstrated a significant reduction in antiemetic administration in the aprepitant group at various postoperative intervals, including within one hour of admission to the post-anesthesia care unit (PACU), as well as at 12 and 24 hours postoperatively. Specifically, the aprepitant group required fewer antiemetic doses (365 vs. 581 for the control group) and showed a reduction in the average length of stay (1.19 days compared to 1.33 days in the control group). Statistical analysis confirmed the significance of these findings, with p-values of less than 0.001 for total antiemetic doses and length of stay, suggesting that aprepitant effectively reduces PONV and shortens hospital stays. This study supports the consideration of aprepitant as a complementary treatment to existing PONV prophylaxis in bariatric surgery patients. [8]