Methylnaltrexone bromide for the treatment of opioid-induced constipation in patients with advanced illness--a cost-effectiveness analysis.
BACKGROUND
Opioid-induced constipation is a common adverse event in patients with advanced illness and has a significant negative impact on patients' quality of life and costs.


OBJECTIVE
To examine the cost-effectiveness of treating opioid-induced constipation with methylnaltrexone bromide (MNTX) plus standard care compared with standard care alone in patients with advanced illness who receive long-term opioid therapy from a third-party payer perspective in the Netherlands.


METHODS
A decision-analytical model was created in which advanced-illness patients with constipation were treated with MNTX plus standard care or standard care alone. Clinical efficacy in terms of percentage of patients with rescue-free laxation and time to rescue-free laxation were obtained from a randomized, controlled clinical study. Resource use, costs, utilities and mortality were obtained from published literature and supplemented with data from clinical experts.


RESULTS
Treatment with MNTX plus standard care results in more days without constipation symptoms. Cost of MNTX was mostly offset by reduction in other constipation-related costs. Thus, treating with MNTX plus standard care is cost-effective, with an incremental cost per QALY of 40,865 euro. Results were robust to changes in all parameters.


CONCLUSIONS
Although using MNTX may increase total costs, MNTX plus standard care is cost-effective in treating advanced-illness patients with opioid-induced constipation.
Earnshaw
S R
SR
RTI Health Solutions, Research Triangle Park, NC 27709, USA. searnshaw@rti.org
Klok
R M
RM
Iyer
S
S
McDade
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects*; D003248:Constipation / Q000139:chemically induced* / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D006801:Humans; D054368:Laxatives / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D009271:Naltrexone / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D000644:Quaternary Ammonium Compounds / Q000191:economics / Q000627:therapeutic use; D019452:Terminally Ill; D055815:Young Adult
D000701:Analgesics, Opioid; D054368:Laxatives; D009292:Narcotic Antagonists; D000644:Quaternary Ammonium Compounds; C032257:methylnaltrexone; D009271:Naltrexone