Postoperative nausea and vomiting has been described as the big little problem in anesthesia, with the overall incidence after anesthesia using volatile anesthetics remaining between 20 and 30%. In patients who receive ambulatory surgery, postoperative nausea and vomiting may lead to delayed discharge or unplanned overnight admission to hospital which is counterproductive to the primary goal of saving costs in healthcare by undergoing day-surgery. The same economic factors apply to patients who experience nausea and vomiting after chemotherapy. Drugs today are judged by their ability to cure a condition with as few adverse reactions as possible. There remains the question of whether a certain medication meets expectations from a pharmacoeconomic point of view. 5-HT3 antagonists are a comparatively new class of drugs that seem to perform satisfactory in the treatment of different forms of nausea and vomiting with few adverse reactions. However, these drugs are comparatively expensive. Studies on the efficacy and pharmacoeconomic comparisons have been conducted. Tropisetron is one of the newest 5-HT3 antagonists. While its efficacy has been shown in several studies, there are few studies on its pharmacoeconomic benefits. There are several antiemetic measures, such as total intravenous anesthesia, using antiemetic prophylaxis or omitting the nitrous oxide with proven effectiveness. Most are roughly equivalent but differ with respect to costs and side effects Routine antiemetic prophylaxis is not indicated due to economic and medical reasons (potential side effects of antiemetics). Patients at high risk can be identified using validated risk scores and should receive antiemetic drugs.