Introduction:  Several organizations have published effective guidelines for CINV. Evidence –based guidelines list the best known regimens for prevention of CINV in different emetic risk groups. While useful, this approach may not address economic realities of availability and affordability of antiemetics in most countries and for most patients. 

Objectives:  Establish a framework addressing affordability of CINV regimens in different economic settings to indicate guidance for improving antiemetic control.

Methods:   We examined current guideline recommendations in 5 CINV risk categories (from high to minimal risk), and as a consensus group listed regimens for each setting as a Good regimen, a Better regimen, or Best regimen. The World Bank / WHO established four economic groups into which each nation is placed.  Additionally, the WHO approached healthcare affordability based on income levels per country (especially minimum wage).  Acquisition price and availability of recommended antiemetics in each country was determined.

Results.  The greatest economic issues were seen in the two top emetic risk groups, where NK1-based regimens were often not affordable except in the highest income nation group (but not in all these countries).  Widespread availability of generic agents has improved affordability. Two-agent regimens were affordable in most economic groups, as were olanzapine-based three agent regimens. Differences still existed among countries of the same economic group.  \    

Conclusions.  The Best antiemetic regimen should always be used where it is available and affordable.  Where economic realities exist limiting Best regimen use, Good and Better regimens provide realistic CINV prevention for many nations. This model may be useful in other oncology settings.

05 / GUIDELINES FOR THE PREVENTION OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING (CINV) DO NOT ADDRESS ECONOMIC VARIATION, AFFORDABILITY IN DIFFERENT POPULATIONS, AND DRUG AVAILABILITY