ZOFRAN ANNUAL PURCHASES BY MD ANDERSON TOTAL $6 MIL., 8% OF DRUG BUDGET

Zofran purchases at the MD Anderson Cancer Center have reached $6 mil. annually, accounting for 8% of the institution's $75 mil. 1992 drug budget, Deputy Pharmacy Division Head Stephen Huber told the mid-year clinical meeting of the American Society of Hospital Pharmacists in December. Although the drug for the prevention of nausea and vomiting associated with chemotherapy is more expensive than other anti- emetic therapies, Zofran's effectiveness up front has made it the drug of choice in several managed care situations, Huber said. The cost of failure, including the cost of hospital admission for dehydration, has been evaluated to be greater than the difference in cost between ondansetron and other drugs. Therefore, Huber suggested, "if you have something that really works better, you'd better use it and find out a way to pay for it." The impact of Zofran on hospital pharmacy budgets was noted a year ago at an ASHP press briefing. Duke University Medical Center reported that it was budgeting $2.2 mil. (10% of its pharmacy budget) for Zofran (" The Pink Sheet" Jan. 20, 1992, T&G-3). MD Anderson's approach to Zofran management has included dose modification. The institution has found that I.V. ondansetron "works very effectively at lower doses" and now recommends a flat dose of 10 mg instead of the 11.5 mg previously used based on the recommended dosage of .15 mg/kg, Huber reported. The center also has started to look at the areas where "the drug clearly doesn't work -- that's in delayed nausea and vomiting." However, Huber warned, many more uses for ondansetron will be found, and "there's no question that you're going to see a significant increase in perioperative use, if you haven't already." An NDA for Zofran for treatment of post-operative nausea is currently pending. In addition, the Dec. 31 approval of an oral formulation of Zofran could greatly expand ondansetron's use. Glaxo expects to launch oral Zofran in April ("The Pink Sheet" Jan. 4, 1992, p. 2).