Pharmacoeconomic analysis of OROS hydromorphone for the treatment of chronic cancer pain under the Brazilian public health care system perspective

Abstract

Objective: To develop cost-effectiveness and budget impact analysis of OROS hydromorphone versus CR morphine and CR oxycodone in moderate to severe cancer pain treatment under the Brazilian public health care system perspective. Methods: A decision tree followed by a Markov Model was developed for a 12 month time horizon. The achievement of mild pain (worst pain scores < 4) was considered as outcome. For the budget impact analysis 10% of CR morphine current utilization was substituted for equivalent OROS hydromorphone. The same rational was adopted for CR oxycodone analysis. Results: The incremental cost-effectiveness ratio was 689 BRL per additional month in mild pain per patient per year, when OROS hydromorphone was compared to CR morphine. Versus CR oxycodone, OROS hydromorphone was more effective and showed lower costs, being cost saving (ICER: 1,634 BRL). The coverage of OROS hydromorphone results in a total cost of 818,121 BRL per year considering 10% of CR morphine substitution for OROS hydromorphone, leading to an additional cost of 118,722 BRL. CR oxycodone for moderate to severe pain treatment shows a total cost of 1,049,694 BRL in one year. Conclusion: OROS hydromorphone is an effective and economically feasible therapeutic option – cost-effective when compared to CR morphine and cost saving when compared to CR oxycodone, with a lower budget impact.