A Comparison of Costs and Efficacy of Ondansetron and Droperidol as Prophylactic Antiemetic Therapy for Elective Outpatient Gynecologic Procedures

TLDR

Ondansetron and droperidol are effective prophylactic antiemetics for outpatient gynecologic procedures, but droperidol can cause drowsiness, delayed discharge, and post‑discharge restlessness, while ondansetron is expensive. This prospective, randomized, double‑blind study compared the efficacy, safety, and cost‑effectiveness of 4 mg IV ondansetron with 0.625 mg or 1.25 mg IV droperidol for preventing postoperative nausea and vomiting after outpatient gynecologic surgery. The investigators recorded PONV incidence, recovery times, and patient‑rated sedation, anxiety, pain, and nausea, then used a decision‑analysis tree to assign costs and probabilities to nine subgroups and calculated cost‑effectiveness ratios by weighting costs and dividing by patients free of PONV and side effects. PONV incidence, rescue antiemetic use, and recovery times were similar for ondansetron and both droperidol doses but differed from placebo, and droperidol 0.625 mg and 1.25 mg had significantly lower cost‑effectiveness ratios than ondansetron and placebo, indicating droperidol 0.625 mg provides comparable prophylaxis without added side effects or delayed discharge and is more cost‑effective. Anesth Analg 1996;83:304‑13.

Abstract

Ondansetron and droperidol are both effective prophylactic antiemetics for gynecologic outpatient procedures.However, increased drowsiness, delayed discharge, and postdischarge restlessness may occur with droperidol, and ondansetron is costly. In this prospective, randomized, double-blind, placebo-controlled study involving 161 women, we compared the efficacy, safety, and cost-effectiveness of ondansetron (4 mg intravenously [IV]) with droperidol (0.625 mg or 1.25 mg IV) in the prevention of postoperative nausea and vomiting (PONV) after outpatient gynecologic surgery. The incidence of PONV, times to achieving preset recovery criteria, and patient-evaluated visual analog scales for sedation, anxiety, pain, and nausea were recorded, along with postdischarge emetic episodes, medications, quality of sleep, and time to resumption of food intake, normal activity, and return to work. A decision analysis tree was used to divide each data set into nine mutually exclusive subgroups, and costs and probabilities were assigned to each subgroup. The cost-effectiveness ratio was determined by summing these weighted costs and dividing by the number of patients free from both PONV and side effects of antiemetic therapy. The incidence of PONV in the hospital and after discharge, the need for rescue antiemetic therapy, and recovery and discharge times were similar for the ondansetron and both droperidol groups but differed significantly from those for the placebo group. The cost-effectiveness ratios for both droperidol 0.625 mg and 1.25 mg groups were significantly lower than those for the ondansetron and placebo groups. We conclude that droperidol 0.625 mg IV provides antiemetic prophylaxis comparable to that of ondansetron 4 mg IV without increasing side effects or delaying discharge and is more cost-effective. (Anesth Analg 1996;83:304-13)