Economic evaluation of the fentanyl transdermal system for the treatment of chronic moderate to severe pain

The fentanyl transdermal system (Duragesic) is an opioid analgesic indicate d for the management of chronic moderate to severe pain. The purpose of thi s analysis is to estimate its economic value compared to two long-acting or al opioids. A cost-utility analysis was performed using a three-phased deci sion analytic model. The transdermal system had the highest expected cost d uring the first year of therapy ($2,491), moderately higher than the cost o f a year of therapy with controlled-release morphine ($2,037) or controlled -release oxycodone ($2,307). The system also had the highest expected numbe r of quality-adjusted life-days (QALDs) (244 compared to 236 for morphine a nd 231 for oxycodone), despite conservative assumptions. The fentanyl trans dermal system achieved incremental cost-utility ratios of $20,709 (vs. morp hine) and $5,273 (vs. oxycodone) per quality-adjusted life year (QALY) gain ed. In a conservative modeled analysis, the fentanyl transdermal system led to increased QALDs at a nominal increased cost. In the absence of head-to- head clinical trials, models help clarify cost and outcome trade-offs and p rovide a consistent theoretical framework for use by individual decisionmak ers. (C) U.S. Cancer Pain Relief Committee, 2001.