A pharmacoeconomic evaluation of aprepitant injection versus aprepitant capsules for the prevention of CINV caused by moderately and highly emetogenic chemotherapy.

OBJECTIVE: To compare the clinical efficacy, safety, and pharmacoeconomic value of aprepitant injection versus aprepitant capsules in preventing chemotherapy-induced nausea and vomiting (CINV) associated with moderately and highly emetogenic chemotherapy, and to provide evidence for optimizing antiemetic strategies and rational healthcare resource allocation. METHODS: This real-world observational study retrospectively included patients with solid tumors who received moderately to highly emetogenic chemotherapy regimens in our hospital from January 2023 to December 2025. Among 368 eligible patients, 62 received aprepitant capsules and 306 received aprepitant injection as part of a. Standard triple antiemetic regimen (NK- one receptor antagonist + 5-HT3 receptor antagonist + dexamethasone). After 1:1 propensity score matching (PSM), 60 matched pairs were included for comparative analysis. Clinical efficacy outcomes included complete response (CR), no nausea rate (NCR), no vomiting rate (NVR), and no rescue treatment rate (NRR) during the overall (0-120 h), acute (0-24 h), and delayed (24-120 h) phases. Quality of life was assessed using the EORTC QLQ-C30 questionnaire. Safety indicators included treatment-related adverse events. Pharmacoeconomic evaluation was conducted from the healthcare system perspective, incorporating antiemetic drug costs, total medication costs (antiemetics, chemotherapy drugs, adjuvant drugs), examination fees, laboratory costs, treatment fees, and total hospitalization costs. Cost-effectiveness analysis (CEA), cost-utility analysis (CUA), incremental cost-effectiveness ratio (ICER), incremental cost-utility ratio (ICUR), Monte Carlo simulation, and cost-effectiveness acceptability curves (CEAC) were applied. RESULTS: After PSM, baseline characteristics between groups were well balanced (P > 0.05). The overall complete response rates were 78.3% in the injection group and 76.7% in the capsule group, with no statistically significant difference (P > 0.05). Acute and delayed phase CR rates, NCR, NVR, and NRR were also comparable between groups (all P > 0.05). Both groups showed significant post-chemotherapy improvements in EORTC QLQ-C30 functional and global health scores, with reduced symptom burden (P < 0.05), while intergroup differences remained non-significant (P > 0.05). The average antiemetic drug cost was significantly lower in the injection group than in the capsule group due to lower acquisition costs. The mean total hospitalization cost was lower in the injection group than in the capsule group (12,856.42 vs. 13,968.57 RMB), corresponding to an incremental cost difference of -1,112.15 RMB. Cost-effectiveness analysis yielded an incremental cost-effectiveness ratio of -66,996.99 RMB per additional complete response achieved, indicating lower costs with slightly improved effectiveness. Cost-utility analysis yielded an incremental cost-utility ratio of -111,215.00 RMB per unit improvement in global health status score. Monte Carlo simulation and CEAC confirmed the robustness of the pharmacoeconomic advantage of aprepitant injection across a wide range of willingness-to-pay thresholds. Safety profiles were comparable, with no significant differences in adverse event incidence. CONCLUSION: Aprepitant injection and aprepitant capsules showed no statistically significant differences in efficacy, safety, or quality-of-life outcomes in this matched retrospective cohort. However, aprepitant injection demonstrated superior pharmacoeconomic performance through lower antiemetic drug costs, reduced total hospitalization expenditures, and more favorable economic outcomes. From a healthcare resource utilization perspective, aprepitant injection may represent a more cost-effective prophylactic antiemetic strategy and could provide useful evidence for individualized clinical decision-making and reimbursement policy optimization.