title: 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.
authors.affiliation: Health Economics and Outcomes Research, IMS HEALTH GmbH & Co. OHG, 90402, Nuremberg, Germany. BHass@de.imshealth.com
authors.forename: Bastian
authors.initials: B
authors.lastname: Hass
authors.forename: Juliane
authors.initials: J
authors.lastname: Lungershausen
authors.forename: Nadine
authors.initials: N
authors.lastname: Hertel
authors.forename: Barbara
authors.initials: B
authors.lastname: Poulsen Nautrup
authors.forename: Wioletta
authors.initials: W
authors.lastname: Kotowa
authors.forename: Hiltrud
authors.initials: H
authors.lastname: Liedgens
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000191:economics*; D002047:Buprenorphine / Q000009:adverse effects / Q000191:economics; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D050723:Fractures, Bone / Q000191:economics*; D005858:Germany; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D010098:Oxycodone / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D010146:Pain / Q000188:drug therapy*; D019057:Quality-Adjusted Life Years
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D009020:Morphine; D010098:Oxycodone