ESTIMATED COSTS ASSOCIATED WITH DIFFERENT FRACTURE RISKS RELATED TO OPIOID TREATMENT IN GERMANY

Kotowa W¹, Voelkl M¹, Hass B¹, Poulsen Nautrup B^2
1IMS Health, Nuremberg, Germany, ²Grόnenthal GmbH, Aachen, Germany

OBJECTIVES: Strong opioids are widely used for many chronic pain conditions. In a Danish nationwide register-based case-control study an increased risk for osteoporotic fractures was shown for opioid users and explained by falls due to central nervous system side effects, such as dizziness. Odds ratios were calculated for osteoporotic patients on treatment for at least 10 days with tramadol, morphine, fentanyl, oxycodone, and buprenorphine, being lowest with buprenorphine. The purpose of this study was to evaluate the costs related with an increased risk of hip, forearm or spine fractures in patients on tramadol, morphine, fentanyl, oxycodone, and buprenorphine treatment in Germany. METHODS: Treatment costs for fractures were obtained from published sources for the year 2006, including direct costs within the first year after fracture, i.e. in- and outpatient treatment, rehabilitation and long-term care (the latter only for social security perspective). Information on patients with osteoporosis in Germany was derived from published data. Perspectives were those from German social security (GSS) and statutory health insurance (SHI). RESULTS: Mean costs per patient due to the treatment of fractures from the GSS/SHI perspective were €833/€430 for tramadol, €408/€214 for morphine, €645/€341 for fentanyl, €465/€242 for oxycodone, and €307/€171 for buprenorphine, respectively. Taking into consideration the estimated number of patients with osteoporosis treated with tramadol, morphine, fentanyl or oxycodone of 2.6 million in Germany, additional annual costs for the treatment of fractures that could be saved with buprenorphine were calculated to €1.0 and €0.5 billion (GSS and SHI, respectively). Sensitivity analyses on costs and fracture rates showed the robustness of model's results. CONCLUSION: An increased fracture risk associated with tramadol, morphine, fentanyl and oxycodone results in a considerable economic burden for the social system which can be reduced by using opioids associated with lower fracture risks, such as buprenorphine.

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