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Meta-Analysis
. 2020 Apr 17;15(4):e0231763.
doi: 10.1371/journal.pone.0231763. eCollection 2020.

Oxycodone versus morphine for cancer pain titration: A systematic review and pharmacoeconomic evaluation

Junxiang Zhou  1 , Yixin Wang  2 , Gang Jiang  1
Affiliations
Meta-Analysis

Oxycodone versus morphine for cancer pain titration: A systematic review and pharmacoeconomic evaluation

Junxiang Zhou et al. PLoS One. .

Abstract

Objective: To evaluate the efficacy, safety and cost-effectiveness of Oxycodone Hydrochloride Controlled-release Tablets (CR oxycodone) and Morphine Sulfate Sustained-release Tablets (SR morphine) for moderate to severe cancer pain titration.

Methods: Randomized controlled trials meeting the inclusion criteria were searched through Medline, Cochrane Library, Pubmed, EMbase, CNKI,VIP and WanFang database from the data of their establishment to June 2019. The efficacy and safety data were extracted from the included literature. The pain control rate was calculated to eatimate efficacy. Meta-analysis was conducted by Revman5.1.4. A decision tree model was built to simulate cancer pain titration process. The initial dose of CR oxycodone and SR morphine group were 20mg and 30mg respectively. Oral immediate-release morphine was administered to treat break-out pain. The incremental cost-effectiveness ratio was performed with TreeAge Pro 2019.

Results: 19 studies (1680 patients)were included in this study. Meta-analysis showed that the pain control rate of CR oxycodone and SR morphine were 86% and 82.98% respectively. The costs of CR oxycodone and SR morphine were $23.27 and $13.31. The incremental cost-effectiveness ratio per unit was approximate $329.76. At the willingness-to-pay threshold of $8836, CR oxycodone was cost-effective, while the corresponding probability of being cost-effective at the willingness-to-pay threshold of $300 was 31.6%. One-way sensitivity analysis confirmed robustness of results.

Conclusions: CR oxycodone could be a cost-effective option compared with SR morphine for moderate to severe cancer pain titration in China, according to the threshold defined by the WHO.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Decision tree model for moderate to severe cancer pain titration.
Fig 2
Fig 2. Flow chart of study selection.
Fig 3
Fig 3. Risk of bias graph.
Fig 4
Fig 4. Risk of bias summary.
Fig 5
Fig 5. Funnel plot of effective rate.
Fig 6
Fig 6. Funnel plot of constipation.
Fig 7
Fig 7. Funnel plot of nausea and vomiting.
Fig 8
Fig 8. Funnel plot of pruritus.
Fig 9
Fig 9. Funnel plot of urinary retentron.
Fig 10
Fig 10. Funnel plot of anorexia.
Fig 11
Fig 11. Cost-effectiveness acceptability curve.
Fig 12
Fig 12. Scatter plot: incremental cost-effectiveness based on 1000 Monte Carlo simulations.
See this image and copyright information in PMC

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