Goeree Ron, Goeree Jeff
a a Goeree Consulting Limited , Hamilton, Ontario , Canada.
b bProfessor Emeritus , McMaster University , Hamilton, Ontario , Canada.
J Med Econ. 2016;19(3):277-91. doi: 10.3111/13696998.2015.1116992. Epub 2015 Nov 30.
Approximately 20-30% of Canadians suffer from chronic pain. Guidelines for the management of chronic pain support the use of controlled-release (CR) opioids to treat chronic pain. Although effective in managing chronic pain, oxycodone is associated with high rates of opioid-induced constipation (OIC). The cost-effectiveness of a combination of oxycodone for the management of pain and naloxone for the relief of OIC has not previously been evaluated for Canada.
A decision analytic model was developed to estimate the cost-utility of combination oxycodone/naloxone compared to oxycodone alone in four populations. Drug costs for managing pain and healthcare costs related to managing OIC were included in the analysis and the primary measure of effectiveness was quality adjusted life years (QALYs) derived from OIC rates observed in clinical trials. The analysis was conducted from a healthcare system perspective, used a 1-year time horizon, and results were expressed in 2015 Canadian dollars.
In all four patient populations, there was a trade-off between slightly higher total expected costs for Targin treated patients compared to oxycodone treated patients, but also improved clinical benefits in terms of reduced OIC, which resulted in higher QALYs for patients. Although analgesic costs were found to be slightly higher for Targin treated patients, Targin also resulted in cost offsets to the healthcare system in terms of less rescue laxative drug use and other resources required for the management of OIC. The resulting 1-year cost-utility of Targin compared to oxycodone ranged from $2178-$7732 per QALY gained in the base case analysis, and it was found that these cost-utility results remained robust and at low values throughout a series of one-way deterministic analyses of uncertainty.
The clinical effectiveness of oxycodone/naloxone in managing pain and OIC compared to CR oxycodone alone resulted in low cost-utility estimates.
约20% - 30%的加拿大人患有慢性疼痛。慢性疼痛管理指南支持使用控释（CR）阿片类药物治疗慢性疼痛。尽管羟考酮在管理慢性疼痛方面有效，但它与阿片类药物引起的便秘（OIC）的高发生率相关。此前尚未对加拿大使用羟考酮治疗疼痛和纳洛酮缓解OIC的联合用药的成本效益进行评估。
开发了一个决策分析模型，以估计在四类人群中，与单独使用羟考酮相比，羟考酮/纳洛酮联合用药的成本效益。分析中纳入了治疗疼痛的药物成本和与管理OIC相关的医疗保健成本，有效性的主要衡量指标是从临床试验中观察到的OIC发生率得出的质量调整生命年（QALYs）。该分析从医疗保健系统的角度进行，采用1年的时间范围，结果以2015年加拿大元表示。
在所有四类患者群体中，与接受羟考酮治疗的患者相比，接受Targin治疗的患者总预期成本略高，但在减少OIC方面有更好的临床益处，这导致患者的QALYs更高，两者之间存在权衡。尽管发现接受Targin治疗的患者的镇痛成本略高，但Targin在减少救援泻药使用和管理OIC所需的其他资源方面也为医疗保健系统带来了成本抵消。在基础案例分析中，与羟考酮相比，Targin产生的1年成本效益为每获得一个QALY 2178 - 7732加元，并且发现在一系列单向确定性不确定性分析中，这些成本效益结果保持稳健且处于低值。
与单独使用CR羟考酮相比，羟考酮/纳洛酮在管理疼痛和OIC方面的临床有效性导致成本效益估计值较低。
