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Modeling the economic and health consequences of managing chronic osteoarthritis pain with opioids in Germany: comparison of extended-release oxycodone and OROS hydromorphone.
Curr Med Res Opin. 2007 Oct; 23(10):2333-45.CM

Abstract

OBJECTIVE

The Osmotic controlled-Release Oral delivery System (OROS) hydromorphone ensures continuous release of hydromorphone over 24 hours. It is anticipated that this will facilitate optimal pain relief, improve quality of sleep and compliance. This simulation compared managing chronic osteoarthritis pain with once-daily OROS hydromorphone with an equianalgesic dose of extended-release (ER) oxycodone administered two or three times a day.

METHODS

This discrete event simulation follows patients for a year after initiating opioid treatment. Pairs of identical patients are created; one receives OROS hydromorphone the other ER oxycodone; undergo dose adjustments and after titration can be dissatisfied or satisfied, suffer adverse events, pain recurrence, or discontinue the opioid. Each is assigned an initial sleep problems score, and an improved score from a treatment dependent distribution at the end of titration; these are translated to a utility value. Utilities are assigned pre-treatment, updated until the patient reaches the optimal dose or is non-compliant or dissatisfied. The OROS hydromorphone and ER oxycodone doses are converted to equianalgesic morphine doses using the following ratios: hydromorphone to morphine ratio; 1:5, oxycodone to morphine ratio; 1:2. Sensitivity analyses explored uncertainty in the conversion ratios and other key parameters. Direct medical costs are in 2005 euros.

RESULTS

Over 1 year on a mean daily morphine-equivalent dose of 90 mg, 14% were estimated to be dissatisfied with each opioid. OROS hydromorphone was predicted to yield 0.017 additional quality-adjusted life years (QALYs)/patient for a small additional annual cost (E141/patient), yielding an incremental cost-effectiveness ratio (ICER) of E8343/QALY gained. Changing the assumed conversion ratio for oxycodone:morphine to 1:1.5 led to lower net costs of E68 per patient, E3979/QALY, and for hydromorphone to 1:7.5 to savings.

CONCLUSION

Based on these analyses, OROS hydromorphone is expected to yield health benefits at reasonable cost in Germany.

Authors+Show Affiliations

Caro Research Institute, Concord, MA 01742, USA. alexward@caroresearch.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17697453

Citation

Ward, Alexandra, et al. "Modeling the Economic and Health Consequences of Managing Chronic Osteoarthritis Pain With Opioids in Germany: Comparison of Extended-release Oxycodone and OROS Hydromorphone." Current Medical Research and Opinion, vol. 23, no. 10, 2007, pp. 2333-45.
Ward A, Bozkaya D, Fleischmann J, et al. Modeling the economic and health consequences of managing chronic osteoarthritis pain with opioids in Germany: comparison of extended-release oxycodone and OROS hydromorphone. Curr Med Res Opin. 2007;23(10):2333-45.
Ward, A., Bozkaya, D., Fleischmann, J., Dubois, D., Sabatowski, R., & Caro, J. J. (2007). Modeling the economic and health consequences of managing chronic osteoarthritis pain with opioids in Germany: comparison of extended-release oxycodone and OROS hydromorphone. Current Medical Research and Opinion, 23(10), 2333-45.
Ward A, et al. Modeling the Economic and Health Consequences of Managing Chronic Osteoarthritis Pain With Opioids in Germany: Comparison of Extended-release Oxycodone and OROS Hydromorphone. Curr Med Res Opin. 2007;23(10):2333-45. PubMed PMID: 17697453.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modeling the economic and health consequences of managing chronic osteoarthritis pain with opioids in Germany: comparison of extended-release oxycodone and OROS hydromorphone. AU - Ward,Alexandra, AU - Bozkaya,Duygu, AU - Fleischmann,Jochen, AU - Dubois,Dominique, AU - Sabatowski,Rainer, AU - Caro,J Jaime, PY - 2007/8/19/pubmed PY - 2007/12/15/medline PY - 2007/8/19/entrez SP - 2333 EP - 45 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 23 IS - 10 N2 - OBJECTIVE: The Osmotic controlled-Release Oral delivery System (OROS) hydromorphone ensures continuous release of hydromorphone over 24 hours. It is anticipated that this will facilitate optimal pain relief, improve quality of sleep and compliance. This simulation compared managing chronic osteoarthritis pain with once-daily OROS hydromorphone with an equianalgesic dose of extended-release (ER) oxycodone administered two or three times a day. METHODS: This discrete event simulation follows patients for a year after initiating opioid treatment. Pairs of identical patients are created; one receives OROS hydromorphone the other ER oxycodone; undergo dose adjustments and after titration can be dissatisfied or satisfied, suffer adverse events, pain recurrence, or discontinue the opioid. Each is assigned an initial sleep problems score, and an improved score from a treatment dependent distribution at the end of titration; these are translated to a utility value. Utilities are assigned pre-treatment, updated until the patient reaches the optimal dose or is non-compliant or dissatisfied. The OROS hydromorphone and ER oxycodone doses are converted to equianalgesic morphine doses using the following ratios: hydromorphone to morphine ratio; 1:5, oxycodone to morphine ratio; 1:2. Sensitivity analyses explored uncertainty in the conversion ratios and other key parameters. Direct medical costs are in 2005 euros. RESULTS: Over 1 year on a mean daily morphine-equivalent dose of 90 mg, 14% were estimated to be dissatisfied with each opioid. OROS hydromorphone was predicted to yield 0.017 additional quality-adjusted life years (QALYs)/patient for a small additional annual cost (E141/patient), yielding an incremental cost-effectiveness ratio (ICER) of E8343/QALY gained. Changing the assumed conversion ratio for oxycodone:morphine to 1:1.5 led to lower net costs of E68 per patient, E3979/QALY, and for hydromorphone to 1:7.5 to savings. CONCLUSION: Based on these analyses, OROS hydromorphone is expected to yield health benefits at reasonable cost in Germany. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/17697453/Modeling_the_economic_and_health_consequences_of_managing_chronic_osteoarthritis_pain_with_opioids_in_Germany:_comparison_of_extended_release_oxycodone_and_OROS_hydromorphone_ DB - PRIME DP - Unbound Medicine ER -