Highlights
- •Regular, low-dose, oral morphine improves health-related quality of life in COPD.
- •Healthcare and societal costs are improved after four weeks of morphine.
- •Therefore, regular, low-dose, oral morphine can be considered cost-effective.
- •Morphine should be considered in patients with COPD and chronic breathlessness.
Abstract
Background
Chronic breathlessness is a frequent symptom in advanced Chronic Obstructive Pulmonary
Disease (COPD) and has major impact on quality of life, daily activities and healthcare
utilization. Morphine is used as palliative treatment of chronic breathlessness. The
aim is to analyze cost-effectiveness of regular, low-dose morphine in patients with
advanced COPD from a healthcare and societal perspective.
Methods
In a randomized controlled trial, participants with advanced COPD were assigned to
10 mg regular, oral sustained-release morphine or placebo twice daily for four weeks.
Quality of life (COPD Assessment Test; CAT), quality-adjusted life years (QALY's;
EQ-5D-5L), healthcare costs, productivity, and patient and family costs were collected.
Incremental cost-effectivity ratio's (ICERs) using healthcare costs and CAT scores,
and incremental cost-utility ratio's (ICURs) using societal costs and QALY's were
calculated.
Results
Data of 106 of 124 participants were analyzed, of which 50 were in the morphine group
(mean [SD] age 65.4 [8.0] years; 58 [55%] male). Both ICER and ICUR indicated dominance
for morphine treatment. Sensitivity analyses substantiated these results. From a healthcare
perspective, the probability that morphine is cost-effective at a willingness to pay
€8000 for an minimal clinically important difference of 2 points increase in CAT score
is 63%. From a societal perspective, the probability that morphine is cost-effective
at a willingness to pay €20,000 per QALY is 78%.
Conclusion
Morphine for four weeks is cost-effective regarding the healthcare and the societal
perspective. To estimate the long-term costs and effects of morphine treatment, a
study of longer follow-up should be performed.
Trial registration
ClinicalTrials.gov (NCT02429050).
Keywords
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Article info
Publication history
Published online: February 09, 2021
Accepted:
February 2,
2021
Received in revised form:
January 22,
2021
Received:
October 14,
2020
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
