Background: Unscheduled hydrations (UHs) can significantly increase the cost of care in patients receiving moderately or highly emetogenic chemotherapy (MEC or HEC). Granisetron extended-release subcutaneous injection (GERSC) is a unique formulation of granisetron for prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV). Limited data are available regarding the impact of GERSC on cost of UHs compared to other antiemetics. Objective: Assess costs of an UHs associated with breakthrough CINV following GERSC or palonosetron (PALO) for preventing CINV in patients receiving MEC or HEC. Methods: Retrospective analysis of medical records from a single multicenter community-based practice involving patients receiving MEC or HEC with a 3-drug antiemetic regimen (neurokinin-1 receptor antagonist, dexamethasone, and either GERSC or PALO). Cost of care analysis for GERSC and PALO was based on maximum per-unit Medicare reimbursement for UHs, rescue antiemetic drugs and administration, laboratory, and office evaluations. Results: 182 patient records (n = 91 GERSC; n = 91 PALO) were evaluated. A lower number of median UHs per-patient were observed following GERSC versus PALO (HEC, 3 vs 5) and (MEC, 2 vs 3). Mean cost of care related to UHs was significantly lower per-patient following GERSC ($296, n=91) versus palonosetron ($837, n=91) (P< 0.0001), including when the subset analysis was restricted to those patients requiring hydration (Table).When analyzing individual components of care, hydration (CPT codes 96360 and 96361) costs per-patient receiving HEC or MEC were lower following GERSC ($62, n=91) versus PALO ($253, n=91) (P< 0.0001). Lower per-patient costs were observed following GERSC in all components of care except rescue antiemetic drug costs in MEC patients. Conclusions: GERSC reduced total per-patient costs of care associated with UHs visit relative to PALO in patients receiving HEC or MEC.

GERSC = granisetron extended-release subcutaneous injection. ^aValues represent the mean. ^bP-values are from Wilcoxon rank sum test. ^cThe median value for GERSC was $0. ^dThe median value for Palonosetron was $587.