Pain management with buprenorphine patches in elderly patients: Quality of life—As good as it gets?

Abstract

In this issue of Scandinavian Journal of Pain, Norrlid and coworkrs [1] report on pain management with buprenorpine patches in ersistent, non-malignant pain in patients aged over 50 years. In heir study, data on health related quality of life (HRQoL) from ublished studies [2–5] were analysed. In their analysis, altogether 401 patients with moderate to evere pain from osteoarthrosis of the knee and hip, completed EQD questionnaires before (baseline) and 3–6 months after titration ith buprenorphine patches. In spite of the questionnaire’s apparnt simplicity, EQ-5D allows for 243 different levels of HRQoL, from erfect health to death [1]. Following titration with buprenorphine atches, HRQoL improved, although a number of included patients, p to 30%, discontinued due to side effects. The cost for a year of analgesic management with either uprenorphine patches in a dose of 10–15 g/h and/or full dose of aracetamol/acetaminophen alone (up to 4 g/day) was calculated. he cost of health care visits, extrapolated from three up to 12 visits er year, was added to the total cost of care. Ideally, patients increase activity and thus quality of life, as a onsequence of improved pain control. What is acceptable and clincally significant pain relief to a patient and thus improvement of RQoL, on an individual basis and in a larger group of individuals? ow much is this worth to the elderly patient suffering from modrate pain due to osteoarthritis and how much is it worth to society? nterview studies from the UK and from Sweden have arrived at ifferent numbers [1]. Both Swedish and UK weights were used by orrlid et al. [1] in order to compare the incremental cost effectiveess ratios (ICER) of buprenorphine patches to pain management y paracetamol only. Irrespective of which weights were used, analgesic management ith buprenorphine patches was cost effective, but the Swedish eights produced a larger cost per Quality Adjusted Life Years QALY) than the UK – weights did. The payer, in this case the ational Board of Health and Welfare (NBHW) of Sweden, decides hat is an acceptable upper limit for the cost of QALY, although here are not, as Norrlid et al. point out, general guidelines for the orth of QALY.