Cost-effectiveness analysis of transnasal fentanyl citrate for the treatment of breakthrough cancer pain.
BACKGROUND
Pain is a symptom of cancer and is categorized in two forms: background pain to be treated with analgesics, and breakthrough cancer pain (BTcP), which needs drug treatment on demand. We present a cost-effectiveness analysis of transnasal fentanyl citrate as an alternative to morphine.


METHODS
A Markov model considers a cohort of 100 patients on a daily basis. Effectiveness was included by selecting three clinical studies. Side effects, hospitalizations and visits were valued by referring to national formularies. Utility data were used to differentiate the health status inherent to BTcP.


RESULTS
The incremental cost-effectiveness ratio of transnasal fentanyl citrate is 10,140 euros/QALY. Sensitivity analysis shows that with a threshold of 30,000 euros/QALY, the treatment of BTcP with transnasal fentanyl citrate would have an 86% probability of being cost-effective.


CONCLUSIONS
Transnasal Fentanyl citrate is cost-effective, therefore represents a good investment in health.
ALTEMS (Post graduate school of health economics and management) and Istituto di Politica Economica, Università Cattolica del Sacro Cuore, Rome, Italy.
Matteo
M
Ruggeri
Adriana
A
Turriziani
Marco
M
Oradei
D000281:Administration, Intranasal; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000191:economics; D059390:Breakthrough Pain / Q000188:drug therapy* / Q000523:psychology; D003362:Cost-Benefit Analysis; D005283:Fentanyl / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D008390:Markov Chains; D009369:Neoplasms / Q000503:physiopathology*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
D000701:Analgesics, Opioid; D005283:Fentanyl
BTcP; Markov model; QALYs; cost-effectiveness; sensitivity analysis