Cost-effectiveness of strong opioids focussing on the long-term effects of opioid-related fractures: a model approach

Abstract

Opioid analgesics are known to impact on the central nervous system (CNS). These CNS side effects, such as dizziness and confusion, have been shown to lead to an increased risk of falling with subsequent fractures in elderly patients being treated with opioids. The risk of experiencing fractures has been shown to be dependent on the substance administered. Therefore, a health economic model was developed to investigate the cost-effectiveness of the most commonly used strong opioids in Germany, focussing on opioid-related fractures. By means of a Markov model, the consequences of hip, spine and forearm fractures due to the prior administration of transdermal (TD) buprenorphine, TD fentanyl, oral oxycodone as well as oral morphine were assessed from the perspectives of the German statutory health insurance (SHI) and the German social security (GSS) system over a time horizon of 6 years. The most frequently prescribed strength/package-size combinations of these opioids were taken into consideration, including generics where available. The results of the present analysis predict that TD buprenorphine is dominant compared to TD fentanyl and oxycodone by showing better effects [life years gained/quality adjusted life years (QALY) gained] at lower cost. From the SHI perspective, the incremental cost-effectiveness ratio (ICER) compared to morphine is <euro> 6,801.61 per life year gained, and <euro> 7,766.11 per QALY gained. From the GSS perspective, the ICER is <euro> 2,496.77 per life year gained and <euro> 2,850.83 per QALY gained. The model is robust regarding probabilistic variations of all parameters in the sensitivity analyses. Focussing on fractures due to the prior administration of strong opioids, TD buprenorphine is less costly and more effective than TD fentanyl and oxycodone and represents a cost-effective treatment option versus morphine in patients with chronic pain from both the SHI and GSS perspective in Germany.

A cost-effectiveness analysis of E/C/F/TAF vs three boosted regimens in the Italian context

“…To these weights, were then applied the utility decrements related to the development of side effects [43][44][45][46][47][48][49][50] and HIV-related and -unrelated diseases [41,[51][52][53][54][55].…”

Economic evaluation in chronic pain: a systematic review and de novo flexible economic model

“…In line with the majority of previous models [ 6 , 7 , 10 , 13 , 15 , 17 , 18 ], the reference model is a state-transition Markov cohort model. The model structure has been designed and built with sufficient complexity and flexibility to consider the range of uncertainty in design features identified through the systematic literature review.…”

“…The search identified 12 published relevant economic evaluation studies [ 5 – 7 , 10 – 18 ]. From these, eight original model structures were identified [ 5 – 7 , 10 , 13 , 15 , 17 , 18 ], comprising one individual-level discrete event simulation (DES) model [ 12 ] and seven cohort-level state-transition (Markov) models. The most common country settings were the UK [ 10 , 13 , 17 ] and Germany [ 11 , 12 , 15 ]; other studies have been set elsewhere in Europe or the USA.…”

Transdermal buprenorphine &ndash; a critical appraisal of its role in pain management

“…The most frequently prescribed strength/package-size combinations of these opioids were taken into consideration. The results of this analysis predict that BUP TDS is dominant compared to FEN TDS fentanyl and oxycodone by showing better life years gained/quality adjusted life-years (QALY) 82. As such, BUP TDS represents a cost-effective treatment option vs morphine in patients with chronic pain.…”