Cost-effectiveness of tapentadol prolonged release compared with oxycodone controlled release in the UK in patients with severe non-malignant chronic pain who failed 1st line treatment with morphine.
Cost-effectiveness of tapentadol prolonged release compared with oxycodone controlled release in the UK in patients with severe non-malignant chronic pain who failed 1st line treatment with morphine.
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DOI：
10.3111/13696998.2012.670174
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发表时间：
2012-01-01
影响因子：
2.4
通讯作者：
Liedgens, Hiltrud
中科院分区：
文献类型：
--
作者：
Ikenberg, Robert;Hertel, Nadine;Liedgens, Hiltrud
目的：本分析的目的是评估他喷他多 PR（缓释）与羟考酮 CR（控释）相比，对于控释吗啡无效或不耐受的严重非恶性慢性疼痛患者的成本效益。 方法：开发马尔可夫模型，从英国国家卫生服务的角度评估 1 年时间范围内的成本和效益。由于缺乏疗效或耐受性差，患者可以继续接受二线治疗或改用三线阿片类药物。第三线治疗也失败的患者进入了最终的吸收健康状态（第四线）。他喷他多和羟考酮的耐受性、疗效和效用数据来自三项比较性 III 期临床试验。与阿片类药物治疗相关的资源消耗成本来自对匿名患者记录的回顾性数据库分析。结果：模型结果预测，与羟考酮相比，用他喷他多开始二线治疗可带来更高的疗效和更低的成本。对于临床试验中纳入的总体人群，接受他喷他多和羟考酮治疗的每位患者的平均年费用分别为 3543 美元和 3656 美元。他喷他多治疗虽然比羟考酮便宜，但更有效（他喷他多和羟考酮的质量调整生命年 (QALY) 分别为 0.6371 和 0.6237），这意味着他喷他多主导了羟考酮。对于基线时患有严重疼痛的阿片类药物使用过的患者亚组，费用和 QALY 方面的排名保持不变。广泛的敏感性分析表明，关于成本效益的结论是一致的。结论：成本效益研究表明，在英国，用他喷他多代替羟考酮对患有严重非恶性慢性疼痛的患者开始二线治疗可以改善患者的生活质量，并且成本较低。解释结果时的主要限制是使用不同的来源来填充模型以及由于数据外推而限制了普遍性。
OBJECTIVES: The aim of this analysis was to assess the cost-effectiveness of tapentadol PR (prolonged release) compared with oxycodone CR (controlled release) in severe non-malignant chronic pain patients in whom controlled release morphine was ineffective or not tolerated.METHODS: A Markov model was developed to assess costs and benefits over a 1-year time horizon from the National Health Service perspective in the UK. Patients could either continue on 2nd line therapy or switch to 3rd line opioid due to lack of efficacy or poor tolerability. Patients failing also 3rd line therapy entered the final absorbing health state (4th line). Data on tolerability, efficacy, and utilities for tapentadol and oxycodone were obtained from the three comparative phase III clinical trials. Costs of resource consumption associated with opioid treatment were derived from a retrospective database analysis of anonymized patient records.RESULTS: The model results predicted that initiating 2nd line therapy with tapentadol leads to higher effectiveness and lower costs vs oxycodone. For the overall population included in the clinical trials, mean annual costs per patient when treated with tapentadol and oxycodone were 3543 and 3656, respectively. Treatment with tapentadol, while cheaper than oxycodone, was more effective (0.6371 vs 0.6237 quality-adjusted life years (QALYs) for tapentadol and oxycodone, respectively), meaning that tapentadol dominated oxycodone. For the sub-group of opioid-experienced patients with severe pain at baseline the ranking in terms of costs and QALYs remained unchanged. Extensive sensitivity analyses showed that conclusions about the cost-effectiveness are consistent.CONCLUSIONS: The cost-effectiveness study suggested that initiating 2nd line treatment in patients with severe non-malignant chronic pain in the UK with tapentadol instead of oxycodone improves patients' quality-of-life and is less costly. Key limitations when interpreting the results are the use of different sources to populate the model and restricted generalizability due to data extrapolation.