Tramadol and the risk of fracture in an elderly female population: a cost utility assessment with comparison to transdermal buprenorphine

Abstract

IntroductionOpioid treatment for chronic pain is a known risk factor for falls and/or fractures in elderly patients. The latter cause a significant cost to the National Health Service and the Personal Social Services in the UK. Tramadol has a higher risk of fractures than some other opioid analgesics used to treat moderate-to-severe pain and, in the model described here, we investigate the cost effectiveness of transdermal buprenorphine treatment compared with tramadol in a high-risk population.MethodsA model was developed to assess the cost effectiveness of tramadol compared with transdermal buprenorphine over a 1-year time horizon and a patient population of high-risk patients (female patients age 75 or older). To estimate the total cost and quality-adjusted life years (QALYs) of treatment, published odds ratios are used in combination with the published incidence rates of four types of fracture: hip, wrist, humerus and other.ResultsThe model shows tramadol to be associated with 1,058 more fractures per 100,000 patients per year compared with transdermal buprenorphine, resulting in transdermal buprenorphine being cost-effective with an incremental cost-effectiveness ratio of less than £7,000 compared with tramadol. Sensitivity analysis found this result to be robust.LimitationsIn the UK data, there is uncertainty regarding the transdermal buprenorphine odds ratios for fractures. Odds ratios published in Danish and Swedish studies show similar point estimates but are associated with less uncertainty.ConclusionTransdermal buprenorphine is cost-effective compared to tramadol at a willingness-to-pay threshold of £20,000 per QALY.

Opioid intake prior to admission is not increased in elderly patients with low‐energy fractures: A case–control study in a German hospital population

“…Recent reports show an increased risk of fractures in elderly patients with opioid intake (Vestergaard et al., , ; Solomon et al., ; Miller et al., ; Carbone et al., ; Li et al., ; Hirst et al., ). Moreover, fractures in the elderly are associated with an increased mortality (Johnell et al., ; Ioannidis et al., ).…”

Safety of buprenorphine transdermal system in the management of pain in older adults

“…Health economic models developed in Germany and the United Kingdom to investigate the cost-effectiveness of commonly used opioids focused on opioid-related fractures. The results of both models predicted that transdermal buprenorphine represented a cost-effective treatment option compared with other opioids studied [35,36].…”

Pharmacological treatment of chronic non-malignant pain among elderly persons: an integrative review

“…It is the most widely used analgesic, and is the drug of choice for the treatment of mild to moderate pain 15 . Its use in combination with tramadol produces a good response in patients who show no improvement with nonsteroidal anti-inflammatory drugs (NSAIDs) 16 .…”

“…An observational study by Imamura 21 evaluated the effects of the combination of tramadol and acetaminophen in patients with chronic low back pain which had not improved with the use of NSAIDs. While the results showed significant improvement of pain after one month of treatment, more interventional studies are necessary to evaluate the long-term results.According to Hirst et al 16 , tramadol increases the risk of falls and fractures when compared to buprenorphine. Based on data from the British National Health Service, the authors concluded that, even though the drug itself is cheaper, the indirect final costs of falls and fractures are greater than with the use of buprenorphine.…”