TY - JOUR
T1 - Cost-effectiveness of sustained-release morphine for refractory breathlessness in COPD
T2 - A randomized clinical trial
AU - Verberkt, Cornelia A.
AU - Van den Beuken-van Everdingen, Marieke H. J.
AU - Dirksen, Carmen D.
AU - Schols, Jos M. G. A.
AU - Wouters, Emiel F. M.
AU - Janssen, Daisy J. A.
PY - 2021/4
Y1 - 2021/4
N2 - Background: Chronic breathlessness is a frequent symptom in advanced Chronic Obstructive Pulmonary Disease (COPD) and has major impact on quality of life, daily activities and healthcare utilization. Morphine is used as palliative treatment of chronic breathlessness. The aim is to analyze cost-effectiveness of regular, low-dose morphine in patients with advanced COPD from a healthcare and societal perspective.Methods: In a randomized controlled trial, participants with advanced COPD were assigned to 10 mg regular, oral sustained-release morphine or placebo twice daily for four weeks. Quality of life (COPD Assessment Test; CAT), quality-adjusted life years (QALY's; EQ-5D-5L), healthcare costs, productivity, and patient and family costs were collected. Incremental cost-effectivity ratio's (ICERs) using healthcare costs and CAT scores, and incremental cost-utility ratio's (ICURs) using societal costs and QALY's were calculated.Results: Data of 106 of 124 participants were analyzed, of which 50 were in the morphine group (mean [SD] age 65.4 [8.0] years; 58 [55%] male). Both ICER and ICUR indicated dominance for morphine treatment. Sensitivity analyses substantiated these results. From a healthcare perspective, the probability that morphine is cost-effective at a willingness to pay (sic) 8000 for an minimal clinically important difference of 2 points increase in CAT score is 63%. From a societal perspective, the probability that morphine is cost-effective at a willingness to pay (sic) 20,000 per QALY is 78%.Conclusion: Morphine for four weeks is cost-effective regarding the healthcare and the societal perspective. To estimate the long-term costs and effects of morphine treatment, a study of longer follow-up should be performed.
AB - Background: Chronic breathlessness is a frequent symptom in advanced Chronic Obstructive Pulmonary Disease (COPD) and has major impact on quality of life, daily activities and healthcare utilization. Morphine is used as palliative treatment of chronic breathlessness. The aim is to analyze cost-effectiveness of regular, low-dose morphine in patients with advanced COPD from a healthcare and societal perspective.Methods: In a randomized controlled trial, participants with advanced COPD were assigned to 10 mg regular, oral sustained-release morphine or placebo twice daily for four weeks. Quality of life (COPD Assessment Test; CAT), quality-adjusted life years (QALY's; EQ-5D-5L), healthcare costs, productivity, and patient and family costs were collected. Incremental cost-effectivity ratio's (ICERs) using healthcare costs and CAT scores, and incremental cost-utility ratio's (ICURs) using societal costs and QALY's were calculated.Results: Data of 106 of 124 participants were analyzed, of which 50 were in the morphine group (mean [SD] age 65.4 [8.0] years; 58 [55%] male). Both ICER and ICUR indicated dominance for morphine treatment. Sensitivity analyses substantiated these results. From a healthcare perspective, the probability that morphine is cost-effective at a willingness to pay (sic) 8000 for an minimal clinically important difference of 2 points increase in CAT score is 63%. From a societal perspective, the probability that morphine is cost-effective at a willingness to pay (sic) 20,000 per QALY is 78%.Conclusion: Morphine for four weeks is cost-effective regarding the healthcare and the societal perspective. To estimate the long-term costs and effects of morphine treatment, a study of longer follow-up should be performed.
KW - BURDEN
KW - Breathlessness
KW - CAT
KW - COPD
KW - Cost-effectiveness
KW - DISABILITY
KW - DYSPNEA
KW - HEALTH-CARE
KW - Morphine
KW - OBSTRUCTIVE PULMONARY-DISEASE
KW - OPIOIDS
KW - PREVALENCE
KW - QUALITY-OF-LIFE
KW - SYMPTOMS
KW - MANAGEMENT
U2 - 10.1016/j.rmed.2021.106330
DO - 10.1016/j.rmed.2021.106330
M3 - Article
C2 - 33611087
SN - 0954-6111
VL - 179
JO - Respiratory Medicine
JF - Respiratory Medicine
M1 - 106330
ER -