Pharmacoeconomic analysis of the application of strong opioids for the treatment of chronic pain syndrome in patients with pancreatic cancer

Objective: to evaluate the clinical and economic feasibility of opioid therapy based on the analysis of its cost and effectiveness in patients with chronic pain syndrome in pancreatic cancer.Material and methods. An observational prospective study in parallel groups of patients with chronic pain syndrome associated with pancreatic cancer was carried out. The analysis of cost minimization and cost-effectiveness was applied, as well as pharmacoeconomic modeling, which included the construction of a decision tree in patients receiving morphine sulfate (n=45) and fentanyl TTS (n=45) for pain relief. The sensitivity of the obtained data was assessed using one-way analysis.Results. It was shown that the treatment of chronic pain syndrome in patients with pancreatic cancer with opioid analgesics as part of combined treatment is the least expensive in the morphine sulfate group (incremental cost-effectiveness ratio 144.93). Based on the results of modeling, the prognostic factors of influence on the cost of analgesic therapy were determined: the cost of combined analgesic therapy, the cost of treatment of adverse reactions, and the cost-effectiveness ratio.Conclusion. Analgesic therapy of chronic pain syndrome with morphine sulfate in patients with pancreatic cancer is pharmacoeconomically feasible.

A Retrospective Review Following the Addition of Clonidine to a Neonatal Abstinence Syndrome Treatment Algorithm

Objective: To investigate the outcomes associated with the implementation of a neonatal abstinence syndrome (NAS) treatment algorithm utilizing dual therapy with morphine sulfate and clonidine in a level four neonatal intensive care unit (NICU).Study Design: A cohort of neonates (≥35 weeks gestation) born at an academic tertiary medical center between January 1, 2015 and December 31, 2018 who were diagnosed with NAS were retrospectively evaluated following the implementation of a new NAS treatment algorithm. Neonates were categorized in two groups based on if they were treated pre- or post-implementation of the protocol. The primary efficacy outcome was length of hospital stay. Secondary outcomes included the incidence of adverse drug reactions, length of treatment for NAS, and maximum as well as total cumulative dose of each medication used to treat NAS.Results: The implementation of this NAS treatment algorithm significantly reduced the length of hospital stay (30 days vs. 20 days, p = 0.001). In addition, there was a significant decrease in duration of morphine sulfate exposure as well as cumulative dose of morphine required to successfully treat a neonate with NAS in the post-implementation group (26 days vs. 15 days, p = 0.002 and 6.9 mg/kg vs. 3.4 mg/kg, p = 0.031).Conclusion: Addition of clonidine to morphine sulfate as initial therapy for NAS significantly reduced the cumulative exposure as well as duration of exposure to morphine sulfate compared to morphine monotherapy and decrease length of hospital stay.

Triple-Blinded Randomized Study to Evaluate the Effect of Acetaminophen and Morphine Sulfate on Pain Relief in MI-patients

Background: Myocardial infarction is considered to be the most common symptom of cardiovascular diseases. Regarding the limitation of access to Morphine sulphate as a special drug and complications followed, this study aims to compare the treatment effects of intravenous acetaminophen and morphine sulphate on the reduction of pain in MI patients and to improve the cardiac performance. Methods: The present study is a triple-blind randomized control trial in which 70 patients were divided into two separated groups and the pain was measured using Visual Analogue Scale. All analysis was done using SPSS Software at the significance level of 5 percent. Results: 42 patients were male (60%) of whom 20 were in case group and 22 in control group. There were no significant difference between intervention group and control group in terms of VAS score (p = 0.520). The index change of VAS over the time was statistically significant (p=0.001) in intervention and control groups (intra group change). The results of variance analysis with repeated measurements showed that mean differences of Ejection Fraction over time in both groups of intervention and control was not statistically significant (p=0.28). Conclusion: The findings of this study demonstrate that although Acetaminophen does not have an improved effect on pain control and cardiac performance than Morphine sulphate, it can be still an appropriate alternative for Morphine sulfate due to the lack of destructive effects and its availability.