{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T23:34:01Z","timestamp":1783553641949,"version":"3.55.0"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T00:00:00Z","timestamp":1729123200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002701","name":"Ministry of Education","doi-asserted-by":"publisher","award":["2021R1A6A1A03044296"],"award-info":[{"award-number":["2021R1A6A1A03044296"]}],"id":[{"id":"10.13039\/501100002701","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002973","name":"Daiichi-Sankyo","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002973","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>This study was conducted to assess the cost-effectiveness of prophylactic use of ramosetron compared to no antiemetic medications for the prevention of postoperative nausea and vomiting (PONV) from the healthcare payer and societal perspectives in South Korea.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Method<\/jats:title>\n<jats:p>A decision analytic model was constructed to assess the cost-effectiveness of prophylactic ramosetron use versus no antiemetic therapy at 24-hour and 48-hour periods post-surgery over a 5-day duration. The model was populated using costs and utility parameters from published studies as well as from surveys of an expert panel of physicians using structured questionnaires. The cost parameters included the costs of drugs, treatment, patient time, productivity loss, and transportation. Effectiveness was measured using quality adjusted life years (QALYs). The study outcome was the incremental cost-effectiveness ratio (ICER). The parameter uncertainties were addressed using deterministic and probabilistic scenario analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The base-case analysis showed that, on average, patients treated with prophylactic ramosetron had lower costs from both the healthcare payer (US$16.88 vs US$17.33) and societal (US$16.89 vs US$18.72) perspectives and higher QALYs (0.0121 vs 0.0114) over the 5-day study duration compared to patients without any antiemetic medications. Deterministic and probabilistic sensitivity analyses were conducted to examine the robustness of results for the parameters included in the model. The acceptability curve probability showed that treating patients with ramosetron compared to no antiemetic medications was more than 99% cost-effective at a willingness-to pay threshold of US$5,000\/QALY from both payer and societal perspectives.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The results demonstrated that prophylactic use of ramosetron compared to no antiemetic therapy is highly cost-effective to prevent PONV for patients undergoing surgery from both healthcare payer and societal perspectives. The cost effectiveness is the result of the decrease in the incidence of PONV and the direct treatment costs of severe PONV with improved patient quality of life.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0309592","type":"journal-article","created":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T17:36:17Z","timestamp":1729186577000},"page":"e0309592","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness of prophylactic ramosetron in the prevention of postoperative nausea and vomiting"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9974-3709","authenticated-orcid":true,"given":"David","family":"Suh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7780-0813","authenticated-orcid":true,"given":"Dong-Won","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9373-9135","authenticated-orcid":true,"given":"Seung-Mi","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5807-5257","authenticated-orcid":true,"given":"Yu-Seon","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun-Young","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chul-Min","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,10,17]]},"reference":[{"key":"pone.0309592.ref001","doi-asserted-by":"crossref","first-page":"48","DOI":"10.4103\/sja.SJA_401_19","article-title":"Prevalence of postoperative nausea and vomiting: A systematic review and meta-analysis","volume":"14","author":"M Amirshahi","year":"2020","journal-title":"Saudi J Anaesth"},{"key":"pone.0309592.ref002","first-page":"633","article-title":"Influence factors for predicting postoperative nausea and vomiting","volume":"17","author":"EA Cho","year":"2017","journal-title":"Journal of the Korean Contents Association"},{"key":"pone.0309592.ref003","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1213\/ANE.0000000000004833","article-title":"Fourth consensus guidelines for the management of postoperative nausea and vomiting","volume":"13","author":"TJ Gan","year":"2020","journal-title":"Anesth Analg"},{"key":"pone.0309592.ref004","unstructured":"Enhanced Recovery After Surgery Society. ERAS\u00ae Society Guidelines. 2022. https:\/\/erassociety.org\/guidelines\/. Accessed 25 August 2022."},{"key":"pone.0309592.ref005","article-title":"The association of guideline-directed prophylaxis with postoperative nausea and vomiting in adult patients: A single-center, retrospective cohort study","author":"BY Andrew","year":"2024","journal-title":"Anesth Analg"},{"key":"pone.0309592.ref006","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/bja\/aer505","article-title":"Simplified postoperative nausea and vomiting impact scale for audit and post-discharge review","volume":"108","author":"P Myles","year":"2012","journal-title":"Br J Anaesth"},{"key":"pone.0309592.ref007","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1093\/bja\/aep370","article-title":"Development and validation of a postoperative nausea and vomiting intensity scale","volume":"104","author":"R Wengritzky","year":"2010","journal-title":"Br J Anaesth"},{"key":"pone.0309592.ref008","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1093\/bjaceaccp\/mks046","article-title":"Nausea and vomiting after surgery","volume":"13","author":"S Pierre","year":"2013","journal-title":"Continuing Educaiton in Anasethesia, Critical Care & Pain"},{"issue":"6","key":"pone.0309592.ref009","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1007\/BF03013543","article-title":"Cost-effectiveness of prophylactic dolasetron or droperidol vs rescue therapy in the prevention of PONV in ambulatory gynecologic surgery","volume":"46","author":"L Frighetto","year":"1999","journal-title":"Can J Anesth"},{"issue":"4","key":"pone.0309592.ref010","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1097\/00000542-200004000-00012","article-title":"Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo","volume":"92","author":"RP Hill","year":"2000","journal-title":"Anesthesiology"},{"key":"pone.0309592.ref011","doi-asserted-by":"crossref","first-page":"e0186006","DOI":"10.1371\/journal.pone.0186006","article-title":"Comparative efficacy of ramosetron and ondansetron in preventing postoperative nausea and vomiting: An updated systematic review and meta-analysis with trial sequential analysis","volume":"12","author":"A Yokoi","year":"2017","journal-title":"PLoS One"},{"key":"pone.0309592.ref012","doi-asserted-by":"crossref","first-page":"601","DOI":"10.2147\/TCRM.S159211","article-title":"Comparison of ramosetron and ondansetron for the treatment of established postoperative nausea and vomiting after laparoscopic surgery: A prospective, randomized, double-blinded multicenter trial","volume":"14","author":"YS Choi","year":"2018","journal-title":"Ther Clin Risk Manag"},{"key":"pone.0309592.ref013","doi-asserted-by":"crossref","first-page":"565","DOI":"10.23736\/S0375-9393.22.16983-X","article-title":"The efficacy of 5HT3-receptor antagonists in postoperative nausea and vomiting: the role of pharmacogenetics","volume":"89","author":"P Theodosopoulou","year":"2023","journal-title":"Minerva Anestesiol"},{"issue":"12","key":"pone.0309592.ref014","doi-asserted-by":"crossref","first-page":"e0168509","DOI":"10.1371\/journal.pone.0168509","article-title":"Palonosetron and ramosetron compared for effectiveness in preventing postoperative nausea and vomiting: A systematic review and meta-analysis","volume":"11","author":"E Ahn","year":"2016","journal-title":"PLoS One"},{"issue":"4","key":"pone.0309592.ref015","doi-asserted-by":"crossref","first-page":"848","DOI":"10.3349\/ymj.2017.58.4.848","article-title":"Efficacy of palonosetron vs. ramosetron for the prevention of postoperative nausea and vomiting: A meta-analysis of randomized controlled trials","volume":"58","author":"MS Kim","year":"2017","journal-title":"Yonsei Med J"},{"key":"pone.0309592.ref016","unstructured":"Health Insurance Review & Assessment Service. 2023 Weighted Average Price of Drugs by Ingredient and Therapeutic Classes in South Korea. 2023. https:\/\/www.hira.or.kr\/bbsDummy.do?pgmid=HIRAA030017000000&brdScnBltNo=4&brdBltNo=1633&pageIndex=1&pageIndex2=1. Accessed 20 February 2024."},{"key":"pone.0309592.ref017","unstructured":"Korea Institute for Health and Social Affairs, Shin YS, Yoon KJ, Kim SY, K LN. Survey Report of Health Workforce (Report Registration Number: 11-1352000-002563-14). 2018. http:\/\/www.mohw.go.kr\/react\/jb\/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=032901&CONT_SEQ=352714. Accessed 5 August 2022."},{"key":"pone.0309592.ref018","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1007\/s12630-011-9660-x","article-title":"A time-motion economic analysis of postoperative nausea and vomiting in ambulatory surgery","volume":"59","author":"I Parra-Sanchez","year":"2012","journal-title":"Can J Anesth"},{"key":"pone.0309592.ref019","unstructured":"Health Insurance Review & Assessment Service. Healthcare Bigdata Hub: Statisitcs for Inpatients and Outpatients by 3th Level Classification of Disease. 2021. http:\/\/opendata.hira.or.kr\/op\/opc\/olap3thDsInfo.do. Accessed 6 September 2022."},{"key":"pone.0309592.ref020","unstructured":"Korean Statistical Information Service. Wages and Working Hours by Employment Type. 2021. https:\/\/kosis.kr\/search\/search.do. Accessed 5 September 2022."},{"key":"pone.0309592.ref021","unstructured":"Korea Institute for Health and Social Affairs. A Study on Anlaysis of 2000 National Medical Care Resources and Utilization Survey (HMP-01-PJ6-PG5-01P35-0001). Osong, South Korea: Ministry of Health and Welfare2002."},{"key":"pone.0309592.ref022","unstructured":"Health Insurance Review & Assessment Service. Stduy Guidelines for Economic Evaluation of Drugs. Seoul, South Korea: Health Insurance Review & Assessment Service2006."},{"key":"pone.0309592.ref023","unstructured":"Ministry of Korea Health and Welfare. Korea National Health and Nutrition Examination Survey (KNHANES) 2005. http:\/\/www.mohw.go.kr\/react\/jb\/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=032901&CONT_SEQ=336053&page=1. Accessed 25 January 2021."},{"key":"pone.0309592.ref024","doi-asserted-by":"crossref","first-page":"212298","DOI":"10.7573\/dic.212298","article-title":"NEPA, a new fixed combination of netupitant and palonosetron, is a cost-effective intervention for the prevention of chemotherapy-induced nausea and vomiting in the UK","volume":"6","author":"H Cawston","year":"2017","journal-title":"Drugs Context"},{"issue":"2","key":"pone.0309592.ref025","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s00520-019-04824-y","article-title":"Cost-effectiveness of a fixed combination of netupitant and palonosetron (NEPA) relative to aprepitant plus granisetron (APR + GRAN) for prophylaxis of chemotherapy-induced nausea and vomiting (CINV): a trial-based analysis","volume":"28","author":"M Botteman","year":"2020","journal-title":"Support Care Cancer"},{"key":"pone.0309592.ref026","doi-asserted-by":"crossref","first-page":"2881","DOI":"10.1111\/cas.13736","article-title":"Cost-effectiveness of aprepitant in Japanese patients treated with cisplatin-containing highly emetogenic chemotherapy","volume":"109","author":"I Tsukiyama","year":"2018","journal-title":"Cancer Sci"},{"issue":"5","key":"pone.0309592.ref027","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.clinthera.2019.03.011","article-title":"Comparative cost-utility analysis between aprepitant- and fosaprepitant-containing regimens to prevent chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy in Japan","volume":"41","author":"M Kashiwa","year":"2019","journal-title":"Clinical Therapeutics"},{"key":"pone.0309592.ref028","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1097\/01.mjt.0000101829.94820.8f","article-title":"Benefits and risks of granisetron versus ramosetron for nausea and vomiting after breast surgery: A randomized, double-blinded, placebo-controlled trial","volume":"11","author":"Y Fujii","year":"2004","journal-title":"Am J Ther"},{"issue":"2","key":"pone.0309592.ref029","doi-asserted-by":"crossref","first-page":"154","DOI":"10.4097\/kjae.2011.61.2.154","article-title":"The preventative effect of ramosetron on postoperative nausea and vomiting after total thyroidectomy","volume":"61","author":"DC Lee","year":"2011","journal-title":"Korean J Anesthesiol"},{"issue":"1","key":"pone.0309592.ref030","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s00540-012-1473-8","article-title":"Effects of ramosetron and dexamethasone on postoperative nausea, vomiting, pain, and shivering in female patients undergoing thyroid surgery","volume":"27","author":"YK Song","year":"2013","journal-title":"J Anesth"},{"key":"pone.0309592.ref031","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s40273-019-00845-x","article-title":"Evaluating partitioned survival and markov decision-analytic modeling approaches for use in cost-effectiveness analysis: Estimating and comparing survival outcomes","volume":"38","author":"C Smare","year":"2020","journal-title":"Pharm Econ"},{"key":"pone.0309592.ref032","volume-title":"Decision Modelling for Health Economic Evaluation","author":"Oxford University Press","year":"2006"},{"key":"pone.0309592.ref033","doi-asserted-by":"crossref","first-page":"e1210","DOI":"10.1002\/cnr2.1210","article-title":"Parametric survival analysis using R: Illustration with lung cancer data","volume":"3","author":"M Kumar","year":"2020","journal-title":"Cancer Rep (Hoboken)"},{"key":"pone.0309592.ref034","unstructured":"R Core Team. R: A language and environment for statistical computing. 4.2.1 ed. Vienna, Austria: R Foundation for Statistical Computing; 2022."},{"key":"pone.0309592.ref035","first-page":"4","article-title":"A package for survival analysis in R","author":"T. Therneau","year":"2022","journal-title":"R package version 3"},{"issue":"1","key":"pone.0309592.ref036","doi-asserted-by":"crossref","first-page":"36","DOI":"10.3393\/ac.2018.34.1.36","article-title":"Efficacy and safety of ramosetron Injection for nausea and vomiting in colorectal-cancer patients undergoing a laparoscopic colectomy: A randomized, double-blind, comparative study","volume":"34","author":"HE Park","year":"2018","journal-title":"Ann Coloproctol"},{"issue":"1","key":"pone.0309592.ref037","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jclinane.2005.06.005","article-title":"Efficacy and costs of 3 anesthetic regimens in the prevention of postoperative nausea and vomiting","volume":"18","author":"S Purhonen","year":"2006","journal-title":"J Clin Anesth"},{"key":"pone.0309592.ref038","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.ejca.2006.09.019","article-title":"Health outcomes and cost-effectiveness of aprepitant in outpatients receiving antiemetic prophylaxis for highly emetogenic chemotherapy in Germany","volume":"43","author":"F Lordick","year":"2007","journal-title":"Eur J Cancer"},{"key":"pone.0309592.ref039","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1111\/ajco.12170","article-title":"Economic analysis of aprepitant-containing regimen to prevent chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy in Hong Kong","volume":"10","author":"SL Chan","year":"2014","journal-title":"Asia Pac J Clin Oncol"},{"issue":"1","key":"pone.0309592.ref040","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1186\/s12913-019-4281-0","article-title":"Cost-utility analysis of palonosetron in the antiemetic regimen for cisplatin-containing highly emetogenic chemotherapy in Japan","volume":"19","author":"M Kashiwa","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"pone.0309592.ref041","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1080\/11024150201680002","article-title":"Prophylaxis of nausea and vomiting after laparoscopic cholecystectomy with ramosetron: randomised controlled trial","volume":"168","author":"Y Fujii","year":"2002","journal-title":"Eur J Surg"},{"issue":"7","key":"pone.0309592.ref042","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1016\/S0149-2918(02)80025-X","article-title":"Double-blind, placebo-controlled, dose-ranging study of ramosetron for the prevention of nausea and vomiting after thyroidectomy","volume":"24","author":"Y Fujii","year":"2002","journal-title":"Clinical Therapeutics"},{"issue":"12","key":"pone.0309592.ref043","doi-asserted-by":"crossref","first-page":"3100","DOI":"10.1016\/S0149-2918(03)90094-4","article-title":"Randomized, double-blind, placebo-controlled, dose-finding study of the antiemetic effects and tolerability of ramosetron in adults undergoing middle ear surgery","volume":"25","author":"Y Fujii","year":"2003","journal-title":"Clinical Therapeutics"},{"key":"pone.0309592.ref044","unstructured":"Zhang K, Garau M. International Cost-Effectiveness Thresholds and Modifiers for HTA Decision Making: London: Office of Health Economics2020. Available from: https:\/\/www.ohe.org\/publications\/international-cost-effectiveness-thresholds-and-modifiers-hta-decision-making."},{"key":"pone.0309592.ref045","volume-title":"Cost-Effectiveness in Health and Medicine","author":"Oxford University Press","year":"2016","edition":"2"},{"key":"pone.0309592.ref046","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1185\/030079906X104830","article-title":"Postoperative nausea and vomiting following inpatient surgeries in a teaching hospital: a retrospective database analysis","volume":"22","author":"AS Habib","year":"2006","journal-title":"Curr Med Res Opion"},{"key":"pone.0309592.ref047","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/MJT.0b013e3181e7a512","article-title":"Postoperative nausea and vomiting prophylaxis from an economic point of view","volume":"19","author":"R Dzwonczyk","year":"2012","journal-title":"Am J Ther"},{"issue":"8","key":"pone.0309592.ref048","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1007\/s11605-021-04923-4","article-title":"The relationship between postoperative nausea and vomiting and early self-rated quality of life following laparoscopic sleeve gastrectomy","volume":"25","author":"Z Naeem","year":"2021","journal-title":"J Gastrointest Surg"},{"key":"pone.0309592.ref049","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1097\/00000542-199611000-00016","article-title":"The dose-response relation and cost-effectiveness of granisetron for the prophylaxis of pediatric postoperative emesis","volume":"85","author":"GD Cieslak","year":"1996","journal-title":"Anesthesiology"},{"key":"pone.0309592.ref050","doi-asserted-by":"crossref","first-page":"925","DOI":"10.2471\/BLT.15.164418","article-title":"Cost\u2013effectiveness thresholds: pros and cons","volume":"94","author":"MY Bertram","year":"2016","journal-title":"Bull World Health Organ"},{"key":"pone.0309592.ref051","unstructured":"Health Insurance Review & Assessment Service. Press Release: Incremental Cost Effectiveness Ratios Used for Evaluation of New Drugs After Implementaiton of Positive Pricing System Wonju, South Korea. 2022. https:\/\/www.hira.or.kr\/bbsDummy.do?pgmid=HIRAA020041000100&brdScnBltNo=4&brdBltNo=10774&pageIndex=1. Accessed 24 Dec. 2022."},{"key":"pone.0309592.ref052","doi-asserted-by":"crossref","unstructured":"Gan T, Sloan F, Dear GdL, El-Moalem HE, Lubarsky DA. How much are patients willing to pay to avoid postoperative nausea and vomiting? Anesth Analg. 2001;92:393\u2013400. doi:10.1097\/00000539-200102000-00022.","DOI":"10.1213\/00000539-200102000-00022"},{"key":"pone.0309592.ref053","doi-asserted-by":"crossref","first-page":"589","DOI":"10.2165\/00019053-199813050-00011","article-title":"Assessing the willingness of parents to pay for reducing postoperative emesis in children","volume":"13","author":"L. Diez","year":"1998","journal-title":"Pharm Econ"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0309592","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T17:36:47Z","timestamp":1729186607000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0309592"}},"subtitle":[],"editor":[{"given":"Kuo-Cherh","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,10,17]]},"references-count":53,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0309592","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,17]]}}}