Cost/effectiveness evaluation of three fixed combinations of acetaminophen and opioids in the management of acute pain in Colombia

  • Rafael Alfonso Cristancho a. RANDOM Foundation, Bogotá, Colombia. b. University of Washington, Seattle, USA
  • Andres I. Vecino a. RANDOM Foundation, Bogotá, Colombia. b. Johns Hopkins University-School of Public Health, Baltimore, USA
  • Juan Diego Misas Medical Department, Sanofi-Aventis, Bogotá, Colombia
Keywords: Economics, Pharmaceutical, Analgesics, Opioid, Acute Pain, Public Health, Colombia

Abstract

Objective: To compare the cost-effectiveness of three different formulations indicated for moderate and severe acute pain, commercialized in Colombia [acetaminophen 500 mg + codeine 30 mg (AC), acetaminophen 500 mg + hydrocodone 5 mg (AH) and acetaminophen 325 mg+ tramadol 37.5 mg (AT)].

Materials and methods:Cost-effectiveness analysis using the NNT as the health outcome indicator. The costs were evaluated in two specific settings: Institutional Channel (IC), representing the cost for the Colombian Ministry of Health (SISMED 2011); Retail Channel (RC), representing consumer prices, obtained from the IMS annual average for 2011, plus an adjustment to include the average profit margin for pharmacies (10%). The incremental cost effectiveness ratios (ICER) were calculated for the three formulations and the two settings (IC and RC). The intervention values are expressed in Colombian pesos (COP).

Results: The prices/NNT for each formulation were $1816 COP/2.2 for AC, $4772 COP/2.3 for AH and $5342/2.6 for AT. Using these data and taking AC as the comparator, the ICER for the other formulations shows the following results: in the RC, $5065 COP for AT and $19,600 COP for AH; in the IC setting, $8790 COP for AT and $29,460 COP for AH. The probabilistic sensitivity analysis demonstrated that the majority of simulation results fell between the 1st and 4th quadrants of the cost-effectiveness matrix, using AC as a reference.

Conclusion: The analysis, from the payer and patient perspectives, demonstrates that the AC formulation has a lower cost and is more effective inreducingpain within the first 4-6 h after administration, compared with the AH and AT formulations in their specific indications.

References

1. Coda BA, Bonica JJ. General considerations of acute pain. In: Bonica's Management of Pain. 3rd ed. Baltimore: Lippincott Williams & Wilkins; 2001. p. 22-40.
2. Joshi G, Ogunnaike B. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin N Am. 2005;23:21-36.
3. Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009;22:588-93.
4. White PF. Multimodal analgesia: its role in preventing postoperative pain. Curr Opin Investig Drugs. 2008;9:76-82.
5. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2004;100:1573-81.
6. Melnikoval I. Pain market. Nat Rev Drug Discov. 2010;9:589-90.
7. Guyatt GH, Sackett DL, Cook DJ. User's guides to the medical literature II. How to use an article about therapy or prevention. B. What were the results and will they help in caring for my patients? Evidence Based Medicine Working Group. J Am Med Assoc. 1994;271:59-63.
8. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. J Am Med Assoc. 2003;290:2443-54.
9. Cordell WH. Number needed to treat (NNT). Ann Emerg Med. 1999;33:433-6.
10. Bandolier Extra (Evidence - based health care). Acute pain. The 2007 Oxford League Table of Analgesic efficacy. Bandolier. Available from: http://www.medicine.ox.ac.uk/bandolier/booth/painpag/Acutrev/Analgesics/lftab.html [accessed 23.04.12].
11. Ivar S, Dorte G-H. Cost-effectiveness analysis based on the number-needed-to-treat: common sense or non-sense? Health Econ. 2004;13:9-19.
12. Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. 3rd ed. New York: Oxford University Press, Inc.; 2005.
13. Fricke Jr JR, Karim R, Jordan D, Rosenthal N. A double-blind, single-dose comparison of the analgesic efficacy of tramadol/acetaminophen combination tablets, hydrocodone/acetaminophen combination tablets, and placebo after oral surgery. Clin Ther. 2002;24:953-68.
14. Ruyssen-Witrand A, Tubach F, Ravaud P. Systematic review reveals heterogeneity in definition of a clinically relevant difference in pain. J Clin Epidemiol. 2011;64:463-70.
15. Phillips C. Prise en Charge de la Douleur: Réflexions sur l'Economie de la Santé et la Qualité de Vie. Drugs. 2003;63 Suppl. 2:47-50.
16. Long D. The US Pharmaceutical Market: Trends, Issues, & Outlook. IMS Consulting Group; 2011. Available from: http://ncpo.hdma.net/pdfs/long.pdf [accessed 25.06.12].
17. Mar J, et al. Probabilistic cost-effectiveness analysis of the treatment of sleep apnea. Gac Sanit. 2006;20:49.
18. Canada National Opioid Use Guideline Group (NOUGG). Canadian guideline for safe and effective use of opioids for chronic non-cancer pain; 2010. Available from: http://nationalpaincentre.mcmaster.ca/opioid [accessed 25.06.12].
19. Gureje O, Von Korff M, Kola L, Demyttenaere K, He Y, Posada-Villa J, et al. The relation between multiple pains and mental disorders: results from the World Menta Health Surveys. Pain. 2008;135(1-2):82-91.
20. Rosenblum A, Joseph H, Fong C, Kipnis S, Cleland C, Portenoy RK. Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. J Am Med Assoc. 2003;289:2370-8.
21. Pasternak GW. Molecular insights into mu opioid pharmacology: from the clinic to the bench. Clin J Pain. 2010;26 Suppl. 10:S3-9.
22. Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008;11 Suppl. 2:S63-88.
23. Vallejo M, Ruiz F. Aspectos básicos de la farmacología clínica de los analgésicos opioides. In: Opioides en la práctica médica. Bogotá: Asociación Colombiana para el Estudio del Dolor - ACED; 2009.
24. Machado-Alba J, et al. ¿Estamos controlando el dolor posquirúrgico? Rev Colomb Anestesiol. 2013;41:132-8.
How to Cite
1.
Cristancho RA, Vecino AI, Misas JD. Cost/effectiveness evaluation of three fixed combinations of acetaminophen and opioids in the management of acute pain in Colombia. Colomb. J. Anesthesiol. [Internet]. 2015 Jan. 1 [cited 2024 Mar. 28];43(1):87-94. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/489

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Published
2015-01-01
How to Cite
1.
Cristancho RA, Vecino AI, Misas JD. Cost/effectiveness evaluation of three fixed combinations of acetaminophen and opioids in the management of acute pain in Colombia. Colomb. J. Anesthesiol. [Internet]. 2015 Jan. 1 [cited 2024 Mar. 28];43(1):87-94. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/489
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