Economic evaluation of breakthrough pain treatment in patients with chronic cancer pain in Poland

Introduction: The treatment of pain in cancer is a challenge for physicians, patients themselves and their families. It became a standard to use transmucosal fentanyl in the treatment of a breakthrough pain. The aim of the study was to evaluate the economic aspects of medicines containing fentanyl financed from public sources, with a special emphasis on cost-effectiveness, prices and usage of different preparations.

Material and methods: A comparative cost-effectiveness analysis of 3 formulations containing transmucosal fentanyl: buccal tablets, nasal spray and sublingual tablets was performed relative to placebo in Polish conditions. Country-specific cost data were derived from public sources, information on resources from literature and the experts’ opinions, data on efficacy from meta-analysis of randomized controlled clinical trials, utilities from time-trade analysis.

Results: All formulations of fentanyl were used in the treatment of breakthrough pain. A metaanalysis of randomized trials showed that all analyzed preparations have enhanced clinical efficacy compared to placebo. The most commonly used were the doses containing 200 mg of active ingredient, 28 or 40 packages. The main costs groups were those of hospitalization and medication. Under the adopted assumptions the cost of palliative care in the patient’s home seemed to be comparable to the cost of GP visits. The baseline analysis demonstrated that all forms of fentanyl were cost-effective in terms Polish health care system conditions, while fentanyl nasal spray is a dominant preparation.

Conclusions: Choosing the right therapy can help improving patients’ quality of life and leads to optimal healthcare resources allocation.