ArticleJournal of managed care & specialty pharmacy2026
Patient factors and costs associated with prophylactic neurokinin-1 receptor antagonist use among women with invasive breast cancer.
Article in Journal of managed care & specialty pharmacy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn April 2012, the American Society of Clinical Oncology joined the Choosing Wisely (CW) initiative to reduce the use of low-value oncology services. Neurokinin-1 receptor antagonists (NK1-RAs) are a class of expensive antiemetic drugs and are not recommended for patients who receive low to moderate risk emetogenic anticancer agents.
objectiveTo identify patient factors and costs associated with NK1-RAs prophylactic use in a real- world setting post-Choosing Wisely among patients with breast cancer.
methodsUsing Optum's de-identified Clinformatics RESULTS;: Out of 18,515 women included, 7.7% (n = 1,429) received NK1-RAs. As compared with women aged 75 years and older, those aged 50-64 and 65-74 years had 1.96 (95% Cl = 1.50-2.57) and 1.39 (95% Cl = 1.19-1.63) times higher odds to receive NK1-RAs, respectively. Black women (AOR: 1.35; 95% Cl = 1.12-1.63), intravenous low-emetogenic chemotherapy (AOR: 3.94; 95% Cl = 3.16-4.91), enrolled in Medicare low-income subsidy (AOR: 1.49; 95% Cl = 1.08-2.07), had higher odds of receiving prophylactic NK1-RAs as compared with White patients, intravenous moderate emetic risk chemotherapy, and commercial insurance, respectively. In the adjusted analysis for costs, the mean total third-party payer antiemetic-specific costs for women who received steroids only, first-generation serotonin-receptor antagonists (5HT3-RAs) with or without steroids, or second-generation 5HT3-RAs with or without steroids were found to be significantly lower by 97.8% (
conclusionsVariability in the potential overuse of NK1-RAs was driven by certain patient- (age, race and ethnicity), clinical- (emetic risk), and health care- (insurance, health plan type) related factors. Furthermore, the mean total costs reimbursed by payers were significantly higher for those who received NK1-RAs as compared with other antiemetics, except for those who received both first- and second-generation 5HT3-RAs with or without steroids. Guideline-concordant use of NK1-RAs could result in significant cost-avoidance for patients and payers.
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