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

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The European Journal of Health Economics

, Volume 17, Issue 2, pp 217–227

First Online: 11 April 2015Received: 20 August 2014Accepted: 11 February 2015DOI: 10.1007-s10198-015-0673-1

Cite this article as: Hirst, A., Knight, C., Hirst, M. et al. Eur J Health Econ 2016 17: 217. doi:10.1007-s10198-015-0673-1


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.

KeywordsTramadol Fractures Pain Elderly Buprenorphine Cost-effectiveness  Download fulltext PDF

Autor: Alexander Hirst - Chris Knight - Matt Hirst - Will Dunlop - Ron Akehurst


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