Numerous studies about postoperative nausea and vomiting management are available and meta-analyses have helped to define the appropriate doses of the effective drugs. Almost all recent papers include some economical considerations. In order to rationalize the therapeutic protocols, strategies including systematic prophylaxis, treatment of established postoperative nausea and vomiting only, targeted prophylaxis, treatment combinations aimed at secondary prophylaxis, and global management have all been proposed. Published data are not always valid for every clinical setting and a cost-effective policy needs an evaluation effort from the local care providers (incidence of immediate and delayed postoperative nausea and vomiting, cost of an emetic episode, indirect impact of postoperative nausea and vomiting). This is the only way to avoid improper use of conclusions possibly drawn in totally different medical and economical circumstances. Patients consider postoperative nausea and vomiting as the worst postoperative symptom. This translates into the sizeable amount of money patients are willing to pay in order to avoid this major side effect.