Analysis of social and economic aspects of using prolonged forms of opioid analgesics for the treatment of chronic pain syndrome in cancer patients
Authors: Pyadushkina E. A. , Derkach E. V. , Palekhov A. V. 
Published: July 2023

Background. The therapy of chronic pain in cancer patients is a highly topical issue for the modern health care system. Intense pain syndrome involves the prescription of strong opioid analgesics (ОА), most of which are classified as narcotic drugs and are under strict governmental control. In this situation, increasing the use of drugs that are equivalent in dosages to morphine and do not require a special narcotic drug prescription may increase the availability of pain relief for cancer patients and will be less associated with drug addiction.

Objective: to analyze the regulatory, organizational, clinical, and economic criteria that determine the choice and influence the prescription of strong ОА for adequate pain relief in cancer patients with chronic pain syndrome (CPS). Material and methods. The article determines legal and regulatory framework regulating the sphere of providing patients with ОА, presents an expert evaluation of existing barriers that limit the availability of adequate pain treatment, and shows ways to solve these issues. We present the results of an original Russian clinical and economic study evaluating the use of prolonged forms of ОА (tapentadol and morphine) for the treatment of moderate and severe CPS in patients with cancer in the Russian healthcare system. The evidence for comparative clinical efficiency and safety of ОА under consideration is analyzed. The costs of therapy with the drugs in equivalent dosages that provide 1 year of adequate analgesia for intensive CPS in oncology patients are compared.

Results. Differences in the regulatory status of opioids, including requirements for prescribing, storage, record keeping, and use, were shown to affect the availability of pain medication. According to a systematic review of the comparative efficiency and safety of prolonged forms of ОА in the therapy of cancer patients with moderate and severe CPS and a meta-analysis of randomized controlled trials, no differences were found for any of the outcomes studied in the tapentadol and morphine groups: frequency of achieving pain control – risk ratio (RR) 0.88 (95% confidence interval (CI) 0.78–1.00), frequency of using emergency (additional) pain relief – RR 1.16 (95% CI 0.95–1.42), frequency of gastrointestinal adverse events – RR 0.82 (95% CI 0.60–1.12). This suggests comparable efficiency and safety of the drugs. The difference in average cost of 1 patient course of therapy for 1 year between tapentadol and morphine was 17,653.02 rubles (–16.8%). Additional funds released in case of treating the cohort of 100 patients with tapentadol instead of morphine made 1,765,301.96 rubles, which means 20 more patients could be treated with tapentadol for 1 year.

Conclusion. The use of modern effective non-invasive forms of ОА (tapentadol in particular) that have no restrictions imposed by regulatory documents on narcotic drugs prescription will increase availability, as well as reduce costs of adequate therapy of moderate and severe CPS in patients with cancer as compared to the use of equivalent daily doses of morphine.