Cortesi Paolo Angelo, D'Angiolella Lucia Sara, Vellucci Renato, Allegri Massimo, Casale Giuseppe, Favaretti Carlo, Kheiraoui Flavia, Cesana Giancarlo, Mantovani Lorenzo Giovanni
Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.
Palliative Care and Pain Therapy Unit, University Hospital of Careggi, Florence, Italy.
PLoS One. 2017 Jun 27;12(6):e0179523. doi: 10.1371/journal.pone.0179523. eCollection 2017.
Breakthrough cancer Pain (BTcP) has a high prevalence in cancer population. Patients with BTcP reported relevant health care costs and poor quality of life. The study assessed the cost-effectiveness of the available Oral Fentanyl Formulations (OFFs) for BTcP in Italy. A decision-analytical model was developed to estimate costs and benefits associated with treatments, from the Italian NHS perspective. Expected reductions in pain intensity per BTcP episodes were translated into, percentage of BTcP reduction, resource use and Quality-Adjusted-Life-Years (QALYs). Relative efficacy, resources used and unit costs data were derived from the literature and validated by clinical experts. Probabilistic and deterministic sensitivity analyses were performed. At base-case analysis, Sublingual Fentanyl Citrate (FCSL) compared to other oral formulations reported a lower patient's cost (€1,960.8) and a higher efficacy (18.7% of BTcP avoided and 0.0507 QALYs gained). The sensitivity analyses confirmed the main results in all tested scenarios, with the highest impact reported by BTcP duration and health care resources consumption parameters. Between OFFs, FCSL is the cost-effective option due to faster reduction of pain intensity. However, new research is needed to better understand the economic and epidemiologic impact of BTcP, and to collect more robust data on economic and quality of life impact of the different fentanyl formulations. Different fentanyl formulations are available to manage BTcP in cancer population. The study is the first that assesses the different impact in terms of cost and effectiveness of OFFs, providing new information to better allocate the resources available to treat BTcP and highlighting the need of better data.
突破性癌痛（BTcP）在癌症患者群体中具有较高的患病率。BTcP患者报告了相关的医疗保健成本和较差的生活质量。该研究评估了意大利可用的口服芬太尼制剂（OFFs）治疗BTcP的成本效益。从意大利国家医疗服务体系（NHS）的角度出发，开发了一个决策分析模型来估计与治疗相关的成本和效益。将每例BTcP发作时预期的疼痛强度降低转化为BTcP降低的百分比、资源使用情况和质量调整生命年（QALYs）。相对疗效、所使用的资源和单位成本数据来自文献，并经临床专家验证。进行了概率性和确定性敏感性分析。在基础病例分析中，与其他口服制剂相比，舌下含服枸橼酸芬太尼（FCSL）的患者成本较低（1960.8欧元），疗效较高（避免了18.7%的BTcP发作，获得了0.0507个QALYs）。敏感性分析在所有测试场景中均证实了主要结果，其中BTcP持续时间和医疗保健资源消耗参数的影响最大。在OFFs中，FCSL是具有成本效益的选择，因为它能更快地降低疼痛强度。然而，需要开展新的研究，以更好地了解BTcP的经济和流行病学影响，并收集关于不同芬太尼制剂对经济和生活质量影响的更可靠数据。有不同的芬太尼制剂可用于管理癌症患者群体中的BTcP。该研究首次评估了OFFs在成本和有效性方面的不同影响，为更好地分配用于治疗BTcP的可用资源提供了新信息，并强调了获取更好数据的必要性。
