The costs of managing severe cancer pain and potential savings from transdermal administration

The economic evaluation of any new or existing therapy should include a comprehensive appraisal of costs. When evaluating pharmaceutical interventions, it is inappropriate to identify the purchase price alone. Other relevant costs include the costs of time of doctors, nurses and other personnel in administering and monitoring the effects of the therapy, and the costs of treating any side-effects. This study estimates direct National Health Service (NHS) costs in the U.K. of current medical practice in managing severe cancer pain, using a review of the published literature and constructing a cost analysis for four 'typical' patients. Costs are estimated for patients with severe cancer pain in a hospital and an ambulatory setting, with oral and subcutaneous routes of drug administration. The study includes costs of drugs, supplies, equipment and personnel time. The results demonstrate the importance of personnel time costs, and potential cost savings which could result from the use of transdermally administered opioid analgesics.