Cost of managing constipation among terminally ill cancer patients treated with transdermal fentanyl and 12 hour sustained-release morphine in Canada

Summary

This study examined the cost of treating constipation among terminally ill cancer patients receiving transdermal fentanyl and 12 hour sustained-release morphine in Ontario, Canada. A decision tree was constructed that modelled the treatment paths and associated resource use attributable to managing constipation among patients receiving both opioids using a randomised clinical trial and information on patient management obtained from a panel of eight physicians and two community nurses who specialise in palliative care in Ontario. The cost to the Ontario Ministry of Health of managing constipation in a patient receiving transdermal fentanyl and 12 hour sustained-release morphine was estimated to be $31.77 and $52.76 respectively during the first two weeks of treatment. When the opioids' acquisition costs were included, the two-weekly cost of managing a patient with transdermal fentanyl and 12 hour sustained-release morphine was $123.24 and $119.70 respectively. The results were sensitive to the incidence of constipation attributable to each opioid, the rate and length of hospital admission and the efficacy of various treatments for constipation. We conclude that opioid acquisition costs alone should not dictate treatment choice for palliative care, but attention should also be paid to the costs of managing opioid-related adverse events and care should always be tailored to the needs and preferences of individual patients.