OBJECTIVES : Tapentadol is a strong analgesic with similar pain relief but improved gastrointestinal tolerability compared to oxycodone. In a previous cost-analysis tapentadol was cost saving compared to oxycodone for treatment of severe non-malignant pain in Spain. In the meantime a new co-payment scheme was issued in Spain and numerous newly launched generics relevantly reduced oxycodone drug costs. The aim of this study was not only to update the cost-comparison to year 2018, but also to focus on the first month, which commonly represents a dose titration period when analgesia and side effects are balanced and the appropriateness of therapy for the individual patient is assessed.

METHODS : An analytic model was built with the following health states: adequate pain management with no adverse events (AEs) and no treatment discontinuation, AEs but no discontinuation, discontinuation due to lack of efficacy, discontinuation due to AEs, opioid switch after discontinuation. Probabilities of events (AEs, discontinuations) were derived from 3 RCTs as reported previously. Health care resource utilization and unit cost data were derived from published sources and official price list. Total costs were calculated for the first month from the perspective of the Spanish NHS (NHS-P) and societal perspective (S-P, also including co-payment and indirect costs).

RESULTS : The risk of discontinuation from oxycodone treatment was nearly double the risk of tapentadol (32.6% versus 16.3%). Considering the costs associated with AEs and opioid switches, higher daily treatment costs with tapentadol were totally offset, leading to cost savings with tapentadol (NHS-P: €226.05 versus €237.22; S-P: €465.78 versus €470.80).

CONCLUSIONS : Despite higher drug costs compared to generic oxycodone, tapentadol’s better tolerability and the associated lower risk of treatment discontinuation results in cost-savings during the first month, thereby allowing the physician to individually assess the appropriateness of tapentadol treatment without increasing total costs for the NHS or society.