Cost-effectiveness analysis of transnasal fentanyl citrate for the treatment of breakthrough cancer pain

Abstract

Introduction: 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. Conclusion: Transnasal Fentanyl citrate is cost-effective, therefore represents a good investment in health.

Keywords::

• BTcP
• cost-effectiveness
• Markov model
• QALYs
• sensitivity analysis

Financial & competing interests disclosure

This paper has been sponsored with a grant by Grunenthal pharmaceuticals Italy. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Transnasal fentanyl citrate is a cost-effective strategy in the treatment of breakthrough cancer pain.

• A number of limits should be addressed, mainly with regard to the effectiveness and the impact on quality of life as well as the administration route.

• Markov models and probabilistic sensitivity analysis can help to address these limits.

• The results of the economic assessment are in line with the previous literature evidences.

• Further research should address the cost-effectiveness of transnasal fentanyl citrate in different oncologic patients.

Notes

¹The combination EQ 5D 22222 is equivalent to moderate capacity to move, perform activities of daily living, self-care, perception of moderate pain and moderate anxiety. Combination EQ-5D 22232 corresponds to moderate capacity to move, perform activities of daily living, self-care, perception of severe pain and moderate anxiety. Further details are provided in the discussion section of this paper.