A cost-effectiveness analysis assessed oral fentanyl formulations available for the treatment of breakthrough cancer pain, published in PLOS One (published online June 27, 2017; doi:10.1371/journal.pone.0179523).
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Breakthrough pain continues to be an issue of high prevalence in patients with cancer. There are several oral fentanyl formulations that effectively treat breakthrough cancer pain. However, there are no cost-effectiveness analyses that could help clinicians and health decision makers in selecting the best formulations for their patients.
Italian researchers led by Lucia Sara D’Angiolella, Research Centre on Public Health, University of Milan-Bicocca, assessed the cost-effectiveness of multiple oral fentanyl formulations for the treatment of breakthrough cancer pain after 30 minutes post-administration, using the Italian National Health System perspective. Expected reductions in pain intensity per breakthrough cancer pain episodes were translated into percentage of breakthrough cancer pain reduction, resource use, and quality-adjusted life-years (QALYs). Probabilistic and deterministic sensitivity analyses were performed.
Results of the analysis indicated that a lower mean cost, higher percentage of breakthrough cancer pain reduction, and QALYs gained were associated with sublingual fentanyl citrate compared with all other fentanyl formulations at 30-minutes after administration.
Sublingual fentanyl citrate demonstrated an achievable cost saving for each patient at a minimum of €108.4 to a maximum of €815.3 compared with other fentanyl formulations.
The analysis also demonstrated the efficacy of sublingual fentanyl citrate, with 18.7% of breakthrough cancer pain avoided and 0.0507 QALYs gained.
Sensitivity analyses confirmed the results in all tested scenarios, with the highest impact reported by breakthrough cancer pain duration and health care resource consumption.
Researchers concluded that sublingual fentanyl citrate is the most cost-effective option for breakthrough cancer pain treatment due to faster reduction of pain intensity. However, further research is necessary to assess the economic impact of breakthrough cancer pain and the quality of life impact from the various fentanyl formulations.—Zachary Bessette
