PCN87 Budget IMPACT Analysis of the Use of Transdermal Buprenorphine VS Morphine Hydrochloride in Cancer PAIN from the Perspective of the Public Health System in Colombia

Abstract

Estimate the 5-year budgetary impact of transdermal Buprenorphine in the treatment of cancer patients in Clinical stage III-IV with moderate to severe pain vs Morphine from the Colombian General Social Security Health System perspective. A budget impact model with a five year time horizon from the third-party payer perspective was developed. Epidemiologic data were used to quantify the proportion of patients diagnosed with cancer in advanced stages with moderate to severe pain. The model considers two arms: One that includes a program aimed to bring the pain management in line with guidelines for cancer pain according to The Zero Acceptance of Pain Quality Improvement Project [Fortner 2003] and treating with transdermal Buprenorphine; and another reflecting the standard clinical practice and treating with Morphine. Costs include hospitalization, outpatient visits, medical consultations, and medications. Procedures costs are taken from the SOAT 2020 tariff catalog; and the Drug Price Information System (SISMED) for drugs. A probabilistic Sensitivity analyses was conducted on main variables. For a total of 62,741 Colombian cancer patients with moderate to severe pain, the total 5-years cost for treatment with transdermal Buprenorphine was USD$74,894,373 vs USD$99,727,480 for the Morphine Hydrochloride group, predicting five-year savings of USD$24,833,108. The majority of savings came from hospitalization, outpatient visits, medical consultations. one way sensitivity analyses found highest sensitivity associated to the drug cost, followed by the probability of inpatient treatment. Despite the availability of effective analgesic medications, pain is frequently inadequately controlled in cancer patients [Fortner 2003]. Guidelines for the treatment of pain have been poorly adopted, resulting in inconsistent selection of analgesic medication and determinations of appropriate analgesic doses and routes of administration. This budget impact model predicts cost savings for the Colombian General Social Security Health System through adding transdermal Buprenorphine as therapeutic option for cancer patients with moderate to severe pain.