Autori: Vanni Bascape
Objective
This paper discusses the results of a Quality of Life analysis of controlled release oxycodone (Oxycodone CR) vs. transdermal fentanyl (Fentanyl TTS) in cancer pain.
Methods
Clinical trial were identified detailing randomized trials involving one of interventions of interest in malignant pain. All trials were assessed against the following inclusion criteria: the study should be a randomized controlled trial; Oxycodone CR and Fentanyl TTS should have been compared with one or more others or with placebo or usual care. The pain scores were transformed to quality of life weights (utilities) suitable for calculating quality- adjusted life years (QALYs).
Results
The results are shown for an 11-point pain scale anchored at ‘No Pain’ and ‘Worst Ever Pain’and for a 4 point pain scales anchored at ‘No Pain’ and ‘Severe Pain’. The total range in mean EQ5D utility scores over the whole scale was -0.775 for the scale anchored at ‘worst pain ever’ and -0.598 for the scale anchored at ‘severe pain’. Although a large number of reported studies were identified, there were a relatively small number of controlled trials available for the analysis. This resulted in the confidence intervals for the estimated mean utilities and adverse event rates being very wide. There are only small differences in the predicted utility scores between oxycodone (Oxycodone CR) vs. transdermal fentanyl (Fentanyl TTS) in cancer pain. Given the results of the evidence synthesis showing small and uncertain differences between therapies in terms of QALYs, it is not surprising that cost utility ratio is driven largely by acquisition cost. In Italy Oxicodone CR presents a minor impact in resources consumption determined by lower acquisition cost.
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