Journal Outcomes Research

Medical events and resource utilisation in cancer-pain patients treated with strong opioids: an analysis of the UK General Practice Research Database

Peter JH Tooley MBBS1, Ronald F Cookson PhD2, Michael Jones PhD3 and Guy D Nuyts PhD4

1 L'Ancresse, Vale, Guernsey, UK
2 Caversham Park, Reading, UK
3 Jones & Just Pty Ltd and Department of Psychology, Macquarie University, Sydney, Australia
4 Johnson & Johnson Health Economics, Beerse, Belgium

Keywords: opioid, morphine, fentanyl, general practice, resources, cancer pain

Summary
We studied the medical events and use of healthcare resources during general practitioner (GP) management of severe cancer pain. A total of 2 323 anonymised patient records were allocated to three cohorts depending on their initially prescribed strong opioid: TTS-fentanyl (TTS, n=270); immediate-release strong opioids (IRO, n=1909); and other sustained-release strong opioids (SRO, n=144). The groups were comparable for age. TTS tended to be used more in women. Median duration of cancer prior to strong opioid treatment was 7.1, 6.0, and 5.3 months in TTS, IRO and SRO, respectively. Mean duration of strong opioid treatment was 68 days (TTS), 97 days (IRO) and 92 days (SRO). TTS had a similar medical events profile to SRO, but a lower risk of important medical events than IRO. Compared to TTS, patients on IRO had more constipation (relative risk [RR] 1.49; 95% confidence interval [CI] 1.14-1.94), more nausea or vomiting (RR 1.43; 95% CI 1.09-1.88) and more cardiac events (RR 1.95; 95% CI 1.15-3.29); SRO patients had a greater incidence of cardiac events (RR 2.79; 95% CI 1.49-5.22).

Compared to IRO and SRO, fewer TTS patients consumed additional pain medication, laxatives, antibiotics and central nervous system medication. Compared to TTS, IRO patients had a higher rate of hospitalisations (RR 1.95; 95% CI 1.14-3.31) and GP visits (RR 1.21; 95% CI 0.98-1.49).

The use of TTS is associated with improved patient tolerability and a reduction in the use of healthcare resources when compared to other strong opioids.