OBJECTIVES: A decision-analytic model was developed to estimate the cost-utility of once-daily OROS® hydromorphone (HM) against other oral opioids in five European countries (Germany, Denmark, Slovakia, Portugal, and Italy).
METHODS: The decision-analytic cost-utility model was developed to estimate the direct medical costs and quality-adjusted life-years (QALYs) gains associated with once-daily OROS® HM versus sustained-release (SR) morphine, controlled-release (CR) oxycodone, and twice-daily HM over a 1-year time horizon in the management of severe chronic malignant and non-malignant pain. CR oxycodone is not available in Portugal and twice-daily HM is not available in Portugal and Italy, therefore, they were not considered in those countries.
RESULTS: Results from the model demonstrate that for the management of severe chronic non-malignant pain, OROS® HM is cost-effective in all markets when compared to SR morphine or CR oxycodone. Compared to SR morphine, incremental cost-effectiveness ratios (ICERs) ranged from €6624/QALY (Slovakia) to €10,480/QALY (Italy). Compared to CR oxycodone, ICERs ranged from €1191/QALY (Germany) to €8559/QALY (Italy). Compared to twice-daily HM, OROS® HM was dominant (Germany, Slovakia) or had a minimal ICER (Denmark ICER €1048/QALY). For the management of severe chronic malignant pain, comparing OROS® HM to SR morphine, the ICER was highest in Portugal (€21,456/ QALY) and was below €13,500/QALY in the remaining countries. Compared to CR oxycodone, OROS® HM was dominant (Germany) or cost-effective with ICERs that ranged from €1399€/QALY (Denmark) to €10,651/QALY (Italy). OROS® HM was dominant versus twice-daily HM in all countries.
CONCLUSIONS: This model demonstrates that OROS® HM is a cost-effective alternative to widely used oral opioids such as SR morphine and CR oxycodone in the management of severe chronic non-malignant and malignant pain in all five countries. It also showed that OROS® HM is less costly and more effective than twice-daily HM in all countries but Denmark in which the ICER in non-malignant pain was minimal.
