DOI QR코드

DOI QR Code

Pharmacoeconomics Evaluation of Morphine, MS Contin and Oxycodone in the Treatment of Cancer Pain

  • Zhang, Wen-Zhou (Department of Pharmacy, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University) ;
  • Yu, Wei-Jiang (Department of Pharmacy, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University) ;
  • Zhao, Xiu-Li (Department of Pharmacy, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University) ;
  • He, Bao-Xia (Department of Pharmacy, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University)
  • Published : 2014.11.06

Abstract

Objective: To analyze cost-effectiveness of morphine, MS contin and oxycodone in the treatment of cancer pain, providing guidance for rational drug use in the clinic. Methods: Confirmed by histology, a total of 171 patients with various cancers who required analgesic treatment were selected and divided into 3 groups, 57 cases for each group, given morphine, MS contin and oxycodone, respectively. If there appeared a poor short-term effect or aggravated sudden pain during the treatment, a short-acting morphine injection was given and adverse reactions were processed by symptomatic treatment. The pain relief rate and adverse reactions of groups were observed and pharmacoeconomics evaluation was undertaken. Results: The pain relief rates with morphine, MS contin and oxycodone were 89.5%(51/57), 91.2%(52/57) and 93.0%(53/57), respectively, with no difference samong groups (${\chi}^2=4.4489$, P=0.6162). The occurrence rates of adverse reactions were 59.7%(34/57), 54.4%(31/57) and 43.9%(25/57), again with no significant variation (P>0.05). The ratios of cost-effectiveness (C/E) for the 3 groups were $14.6{\pm}7.21$, $15.0{\pm}7.44$ and $16.1{\pm}8.10$. When the price of 3 kinds of analgesics was reduced by 10%, the ratios of cost-effectiveness were $12.2{\pm}6.53$, ($13.4{\pm}6.08$ and $14.5{\pm}6.74$ but there was no differences when compared with before the price adjustment (t=1.86, P=0.0651; t=1.30, P=0.1948; t=1.17, P=0.2453). Conclusion: Morphine, MS contin and oxycodone give similar pain relief and adverse reaction rates but of all, morphine is the preferred drug for the treatment of cancer pain from the perspective of pharmacoeconomics.

Keywords

Cancer pain;morphine;MS contin;oxycodone;phamocoeconomics;cost-effectiveness analysis

References

  1. Budkaew J, Chumworathayi B (2013). Knowledge and attitudes toward palliative terminal cancer care among Thai generalists. Asian Pac J Cancer Prev, 14, 6173-80. https://doi.org/10.7314/APJCP.2013.14.10.6173
  2. Fredheim OM, Dale O, Kaasa S, et al (2010). Morphine or oxycodone tablets for pain? Tidsskr Nor Laegeforen, 130, 1479-81. https://doi.org/10.4045/tidsskr.09.1143
  3. Lee YJ, Hyun MK, Jung YJ, et al (2014). Effectiveness of education interventions for the management of cancer pain: a systematic review. Asian Pac J Cancer Prev, 15, 4787-93. https://doi.org/10.7314/APJCP.2014.15.12.4787
  4. Gong XD, Wang JY, Liu F, et al (2013). Gene polymorphisms of OPRM1 A118G and ABCB1 C3435T may influence opioid requirements in Chinese patients with cancer pain. Asian Pac J Cancer Prev, 14, 2937-43. https://doi.org/10.7314/APJCP.2013.14.5.2937
  5. Ise Y, Wako T, Miura Y, et al (2009). Cost-effective analysis of rotation from sustained-release morphine tablet to transdermal fentanyl of matrix type or sustained-release oxycodone tablet. Gan To Kagaku Ryoho, 36, 2599-603.
  6. King S J, Reid C, Forbes K, et al (2011). A systematic review of oxycodone in the management of cancer pain. Palliat Med, 25, 454-70. https://doi.org/10.1177/0269216311401948
  7. Liang SY, Chen KP, Tsay SL, et al (2013). Relationship between belief about analgesics, analgesic adherence and pain experience in Taiwanese cancer outpatients. Asian Pac J Cancer Prev, 14, 713-6. https://doi.org/10.7314/APJCP.2013.14.2.713
  8. Mahigir F, Khanehkeshi A, Karimi A (2013). Psychological treatment for pain among cancer patients by rational-emotive behavior therapy--efficacy in both India and Iran. Asian Pac J Cancer Prev, 13, 4561-5. https://doi.org/10.7314/APJCP.2012.13.9.4561
  9. Meserve J R, Kaye A D, Prabhakar A, et al (2014). The role of analgesics in cancer propagation. Best Pract Res Clin Anaesthesiol, 28, 139-51. https://doi.org/10.1016/j.bpa.2014.04.004
  10. Mercadante S, Porzio G, Gebbia V (2014). New opioids. J Clin Oncol, 32, 1671-6. https://doi.org/10.1200/JCO.2013.51.8662
  11. Mika J, Popiolek-Barczyk K, Rojewska E, et al (2014). Deltaopioid receptor analgesia is independent of microglial activation in a rat model of neuropathic pain. PLoS One, 9, e104420. https://doi.org/10.1371/journal.pone.0104420
  12. Riley J, Branford R, Droney J, et al (2014). Morphine or oxycodone for cancer-related pain? A randomized, openlabel, controlled trial. J Pain Symptom Manage, 26, [Epub ahead of print].
  13. Shen H, Hu X, Szymusiak M, et al (2014). Orally administered nanocurcumin to attenuate morphine tolerance: comparison between negatively charged PLGA and partially and fully PEGylated nanoparticles. Mol Pharm, 10, 4556-51.
  14. Shinde S, Gordon P, Sharma P, et al (2014). Use of non-opioid analgesics as adjuvants to opioid analgesia for cancer pain management in an inpatient palliative unit: does this improve pain control and reduce opioid requirements? Support Care Cancer, 29, [Epub ahead of print].
  15. Simon S M, Schwartzberg L S (2014). A review of rapid-onset opioids for breakthrough pain in patients with cancer. J Opioid Manag, 10, 207-15. https://doi.org/10.5055/jom.2014.0209
  16. Wiffen P J, Derry S, Moore R A, et al (2014). Impact of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain. Cochrane Database Syst Rev, 5, CD011056.
  17. Yang J, Yang H, Du X, et al (2014). Morphine and DAMGO produce an opposite effect on presynaptic glutamate release via different downstream pathways of $\mu$ opioid receptors in the basolateral amygdala. Neuropharmacology, 86C, 353-61.
  18. Zhou B, Wang J, Yan Z, et al (2012). Liver cancer: effects, safety, and cost-effectiveness of controlled-release oxycodone for pain control after TACE. Radiology, 262, 1014-21. https://doi.org/10.1148/radiol.11110552

Cited by

  1. Intravenous Flurbiprofen Axetil Enhances Analgesic Effect of Opioids in Patients with Refractory Cancer Pain by Increasing Plasma β-Endorphin vol.15, pp.24, 2015, https://doi.org/10.7314/APJCP.2014.15.24.10855
  2. Efficacy, tolerability and acceptability of oxycodone for cancer-related pain in adults: an updated Cochrane systematic review vol.8, pp.2, 2018, https://doi.org/10.1136/bmjspcare-2017-001457
  3. I Radioactive Particle Implantation in Treating Cancer and Its Pain vol.33, pp.5, 2018, https://doi.org/10.1089/cbr.2017.2425