Neighbors D M, Bell T J, Wilson J, Dodd S L
Research Triangle Institute, Research Triangle, NC 27709, USA.
J Pain Symptom Manage. 2001 Feb;21(2):129-43. doi: 10.1016/s0885-3924(00)00247-5.
The fentanyl transdermal system (Duragesic) is an opioid analgesic indicated for the management of chronic moderate to severe pain. The purpose of this analysis is to estimate its economic value compared to two long-acting oral opioids. A cost-utility analysis was performed using a three-phased decision analytic model. The transdermal system had the highest expected cost during the first year of therapy ($2,491), moderately higher than the cost of a year of therapy with controlled-release morphine ($2,037) or controlled-release oxycodone ($2,307). The system also had the highest expected number of quality-adjusted life-days (QALDs) (244 compared to 236 for morphine and 231 for oxycodone), despite conservative assumptions. The fentanyl transdermal system achieved incremental cost-utility ratios of $20,709 (vs. morphine) and $5,273 (vs. oxycodone) per quality-adjusted life year (QALY) gained. In a conservative modeled analysis, the fentanyl transdermal system led to increased QALDs at a nominal increased cost. In the absence of head-to-head clinical trials, models help clarify cost and outcome trade-offs and provide a consistent theoretical framework for use by individual decisionmakers.
芬太尼透皮贴剂（多瑞吉）是一种阿片类镇痛药，适用于治疗慢性中度至重度疼痛。本分析的目的是评估其与两种长效口服阿片类药物相比的经济价值。使用三阶段决策分析模型进行了成本效用分析。在治疗的第一年，透皮贴剂的预期成本最高（2491美元），略高于缓释吗啡一年治疗成本（2037美元）或缓释羟考酮一年治疗成本（2307美元）。尽管采用了保守假设，但该系统的质量调整生命天数（QALD）预期数量也最高（244天，相比之下吗啡为236天，羟考酮为231天）。每获得一个质量调整生命年（QALY），芬太尼透皮贴剂与吗啡相比的增量成本效用比为20709美元，与羟考酮相比为5273美元。在一项保守的模型分析中，芬太尼透皮贴剂在成本名义上增加的情况下导致QALD增加。在缺乏直接对比临床试验的情况下，模型有助于阐明成本和结果的权衡，并为个体决策者提供一个一致的理论框架。
