Cost-effectiveness analysis of oxycodone with naloxone versus oxycodone alone for the management of moderate-to-severe pain in patients with opioid-induced constipation in Canada

Figures & data

Figure 1. Model structure for patients with moderate-to-severe pain and opioid-induced constipation (OIC).

Table 1. Percentage of subjects constipated over time, by treatment group and study.

Week	OXN300136^,69		OXY300637^,70		OXN900139^,49		OXN200138^,70
	OXY	OXN	OXY	OXN	OXY	OXN	OXY	OXN
0	88%	91%	94%	97%	91%	93%	94%	96%
1	82%	63%	90%	67%	86%	65%	73%	73%
2	79%	56%	87%	65%	83%	60%	78%	63%
4	77%	58%	82%	65%	80%	61%	83%	69%
8	75%	51%	78%	58%	76%	54%	–	–
12	67%	49%	73%	53%	70%	51%	–	–

OXY, oxycodone; OXN, oxycodone/naloxone.

Table 2. Mean daily doses (in mg), by treatment group and study.

OXN300136^,69		OXY300637^,70		OXN900139^,49		OXN200138^,71
OXY	OXN	OXY	OXN	OXY	OXN	OXY	OXN
33.0 mg	32.3 mg	71.9 mg	74.4 mg	50.3 mg	50.6 mg	43.1 mg	46.6 mg

OXY, oxycodone; OXN, oxycodone/naloxone; mg, milligram.

Table 3. Mean weekly cost of therapy (2015 CDN dollars), by treatment group and study.

OXN3001		OXY3006		OXN9001		OXN2001
OXY	OXN	OXY	OXN	OXY	OXN	OXY	OXN
$15.86	$19.43	$34.56	$44.90	$24.17	$30.53	$20.71	$28.11

OXY, oxycodone; OXN, oxycodone/naloxone; CDN, Canadian denomination.

Table 4. Cost-utility results for non-malignant chronic pain patients.

Model output	OXN	OXY	Incremental (OXN − OXY)
Probabilistic base-case analysis
QALYs	0.4705	0.4048	0.0657
Cost
Pain/OIC treatment	$1591.79	$1258.95	$332.84
Laxative treatment	$1.16	$2.39	($1.23)
Other costs for OIC management	$120.86	$165.18	($44.31)
Total costs	$1713.82	$1426.52	$287.30
Incremental cost per QALY gained	–	–	$4376
Deterministic analysis
QALYs	0.4706	0.4045	0.0660
Total costs	$1709.50	$1424.37	$285.13
Incremental cost per QALY gained	–	–	$4319

QALY, quality-adjusted life-year; OXY, oxycodone; OXN, oxycodone/naloxone. Additions/subtractions may not match due to rounding.

Figure 2. Cost-utility scatterplot for non-malignant chronic pain patients.

Figure 3. CEACs for non-malignant chronic pain patients. CEAC, cost-effectiveness acceptability curve; ICUR, incremental cost-utility ratio; QALY quality-adjusted life year.

Figure 4. Tornado diagram for non-malignant chronic pain patients. ICUR, incremental cost-utility ratio; QALY, quality-adjusted life year; CI, confidence interval.

Simpson K, Leyendecker P, Holzer P, et al. Fixed-ratio combination oxycodone/naloxone compared with oxycodone alone for the relief of opioid-induced constipation in moderate to severe non-cancer pain. Curr Med Res Opin 2008;24:3503-12

 PubMed Web of Science ®Google Scholar

Rossiter L, Kirson N, Shei A, et al. Medical cost savings associated with an extended-release opioid with abuse-deterrent technology in the US. J Med Econ 2014;17:279-287

 Google Scholar

Löwenstein O, Leyendecker P, Hopp M, et al. Combined prolonged-release oxycodone and naloxone improves bowel function in patients receiving opioids for moderate to severe non-malignant chronic pain: a randomized controlled trial. Expert Opin Pharmacother 2009;10:531-43

 PubMed Web of Science ®Google Scholar

White A, LeCates J, Birnbaum H, et al. Positive subjective measures in abuse liability studies and real-world non-medical use: potential impact of abuse-deterrent opioids on rates of nonmedical use and associated healthcare costs. J Opioid Manag 2015;11:199-210

 PubMedGoogle Scholar

Löwenstein O, Leyendecker P, Lux E, et al. Efficacy and safety of combined prolonged-release oxycodone and naloxone in the management of moderate/severe chronic non-malignant pain: results of a prospectively designed pooled analysis of two randomized, double-blind clincial trials. BMC Clin Pharmacol 2010;10:12

 PubMedGoogle Scholar

Purdue Pharma LP. Clinical Study Report OXN9001. Limburg, Germany: Purdue Pharma LP; 2008

 Google Scholar

Ahmedzai S, Nauck F, Bar-Sela G, et al. A randomized, double-blind, active-controlled, double-dummy, parallel-group study to determine the safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate/severe chronic cancer pain. Palliative Med 2011;26:50-60

 PubMed Web of Science ®Google Scholar

Purdue Pharma LP. Clinical Study Report OXN3001. Limburg, Germany: Purdue Pharma LP; 2007

 Google Scholar