Published Online, 3 June 2004, www.theannals.com, DOI 10.1345/aph.1D109a.
The Annals of Pharmacotherapy: Vol. 38, No. 7, pp. 1324-1325. DOI 10.1345/aph.1D109a
© 2004 Harvey Whitney Books Company.
Comment: therapy switching in patients receiving long-acting opioids
Pontus L Jaderholm, PharmD
Drug Information Specialist Kaiser Permanente 5717 NE 138th Avenue
Portland, Oregon 97230-3409
Pontus.L.Jaderholm{at}kp.org
Published Online, June 3, 2004. www.theannals.com, DOI 10.1345/aph.1D109a
TO THE EDITOR: I read with interest the latest
cost-effectiveness trial on controlled release (CR) oxycodone in hopes of some
useful data.1
Alas, this was just another industry attempt to cloud the data and drive the
bottom line. The study claims therapy switching is less with CR oxycodone and
this, in turn, leads to lower overall healthcare costs. However, the
difference in total healthcare charges between the patients did not depend on
therapy switching between opioids, as was claimed in the article, but rather
on the underlying disease states. It is impossible to compare costs, dollar
for dollar, when there are different numbers of patients representing disease
states for each different drug. To state the obvious, care for a patient with
chronic renal failure will cost much more than care for a patient with
depression; the statistical analysis does not account for this cost
differential. A more appropriate cost evaluation would have been across the
disease state variables; this was not reported in the article.
Further, baseline pretreatment costs were higher for patients in the
switching group, showing a cost bias in favor of oxycodone CR (OxyContin). In
addition, pretreatment healthcare costs for transdermal fentanyl and CR
morphine groups were significantly higher, again showing this bias. Funding
for the study and 2 authors came from Purdue Pharma (OxyContin's manufacturer)
and the rest of the authors were from Policy Analysis, a statistics for-hire
firm in Brookline, MA.
Oxycodone CR, transdermal fentanyl, and CR morphine sulfate have all shown
efficacy in pain relief in cancer and noncancer pain; oxycodone CR has shown a
need for more rescue doses
2,3
and can cause fatal dose dumping if the controlled-release mechanism is
broken4 when
compared with CR morphine sulfate. There has not been a definitive trial
showing patient preference of one opiate over another for pain relief. The
types of studies Policy Analysis performs (retrospective, nonblinded post hoc
analyses) are hypothesis generating, at best, and should not influence
prescribing at any level.
References
- Berger A, Hoffman DL, Goodman S, Delea TE, Seifeldin R, Oster G.
Therapy switching in patients receiving long-acting opioids. Ann
Pharmacother 2004;38:389-95. DOI 10.1345/aph.1D109[Abstract/Free Full Text]
- Heiskanen T, Kalso E. Controlled-release oxycodone and morphine in
cancer related pain. Pain 1997;73:37-45.[CrossRef][Medline]
- Bruera E, Belzile M, Pituskin E, Fainsinger R, Darke A, Harsanyi Z,
et al. Randomized, double-blind, cross-over trial comparing safety and
efficacy of oral controlled-release oxycodone with controlled-release morphine
in patients with cancer pain. J Clin Oncol 1998;16:3222-9.[Abstract]
- Package insert. OxyContin (oxycodone). Black Box warning
section. Stamford, CT: Purdue Pharma, 2003.
