Mapi Values, Houten, The Netherlands.
Value Health. 2011 Mar-Apr;14(2):274-81. doi: 10.1016/j.jval.2010.09.007.
Breakthrough cancer pain (BTCP) represents a considerable economic burden. A decision-analysis model was developed to evaluate the cost-effectiveness of intranasal fentanyl spray (INFS) compared with oral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablet (FBT) for the treatment of BTCP.
The model was parameterized for Sweden to estimate the costs and benefits associated with treatments. Expected reductions in pain intensity (PI; measured on a numeric rating scale ranging from 0 to 10) per BTCP episodes were translated into resource use and quality-adjusted life years (QALYs). Relative analgesic efficacy of interventions was derived from a mixed treatment comparison of six randomized controlled trials. The relationship between PI and utility was obtained from a time-trade off study in the general population. Resource use and unit cost data were obtained from the literature and validated by Swedish clinical experts. The base case scenario assumed three BTCP episodes/day, a background PI of 2, and a time horizon of 180 days. Prices of INFS and OTFC were assumed to be equal with FBT ∼14% less. Uncertainty in the source data was incorporated by probabilistic sensitivity analyses and different scenario analyses.
With INFS, 55% of BTCP (95% uncertainty interval [UI]: 46-68%) was avoided, which is greater than expected with OTFC (29%; UI 22-38%) or FBT (31%; UI 25-39%). INFS was dominating OTFC (resulting in 0.046 QALY gain and saving 174 Euros with a time horizon of 180 days) and cost-effective versus FBT (incremental cost-effectiveness ratio 12203 Euros/QALY). Despite uncertainty in the source data, there is a >99% probability that INFS is the most cost-effective intervention.
Given inherent limitations of modelling studies, the greater efficacy of INFS translates to cost and QALY advantages over competing interventions in the treatment for BTCP in Sweden.
突破性癌症疼痛（BTCP）代表了相当大的经济负担。本研究建立了决策分析模型，旨在评估与口服黏膜芬太尼枸橼酸盐（OTFC）和芬太尼颊片剂（FBT）相比，鼻腔内芬太尼喷雾（INFS）治疗 BTCP 的成本效益。
模型以瑞典为参数化，用于估计与治疗相关的成本和效益。每例 BTCP 发作时预期的疼痛强度（PI；用数字评定量表测量，范围从 0 到 10）降低被转化为资源利用和质量调整生命年（QALY）。干预措施的相对镇痛效果源自 6 项随机对照试验的混合治疗比较。PI 与效用之间的关系来自一般人群的时间权衡研究。资源利用和单位成本数据来自文献，并经瑞典临床专家验证。基础案例情景假设每天有 3 次 BTCP 发作、背景 PI 为 2，时间范围为 180 天。假设 INFS 和 OTFC 的价格相等，而 FBT 则便宜约 14%。通过概率敏感性分析和不同情景分析纳入了原始数据的不确定性。
使用 INFS，可避免 55%的 BTCP（95%置信区间[UI]：46-68%），这比使用 OTFC（29%；UI 22-38%）或 FBT（31%；UI 25-39%）预计的要多。INFS 优于 OTFC（导致 0.046 QALY 获益和 180 天时间范围内节省 174 欧元），并且比 FBT 更具成本效益（增量成本效益比为 12203 欧元/QALY）。尽管原始数据存在不确定性，但 INFS 是最具成本效益的干预措施的可能性大于 99%。
鉴于模型研究的固有局限性，在瑞典，INFS 的疗效更高，与 BTCP 治疗的竞争干预措施相比，具有成本和 QALY 优势。
