(319) Cost-Inefficiency of High-Dose Opioids Therapy in Disease-Free Cancer Survivors: A Real-World, U.S. Payer-Perspective Decision-Tree Analysis

Background: : Advances in cancer diagnosis and treatment options have improved survival, which has resulted in a growing population of cancer survivors. During treatment, patients are exposed to opioids, a cornerstone of cancer pain management. Prior research showed that many survivors continue opioid therapy at progressively higher doses years after the conclusion of treatment. Prolonged exposure to high-dose opioids has been associated with negative health outcomes, including increased risk of opioid use disorder (OUD), adverse events, increased mortality, and may lead to increased utilization of healthcare resources. Studies examining the economic inefficiency of increased opioid exposure in cancer survivors are, to our knowledge, non-existent.

Objective: : To evaluate the cost-inefficiency of long-term escalating high-dose opioids compared to rapid low-dose discontinuation of opioids among disease-free cancer survivors in the United States.

Methods: : A decision-tree model with a two-year time horizon was developed from the U.S. healthcare payer perspective. Longitudinal opioid exposure data were obtained from a retrospective observational study of 610 disease-free survivors treated at VCU Massey Comprehensive Cancer Center. Model inputs regarding OUD, mortality, and costs were obtained from published peer-reviewed literature and public data. Utility values for the health states considered in the model were obtained from the scientific literature and used to estimate quality-adjusted life years (QALYs). Uncertainty of the model was assessed with a one-way sensitivity analysis.

Results: : The base-case results show that continued escalating high-dose opioid exposure resulted in higher costs ($41,072 vs. $34,223) and fewer QALYs (1.143 vs. 1.287) compared to rapid low-dose opioid discontinuation. Therefore, rapid discontinuation exhibited dominance in the analysis (ICER: –$47,785/QALY). The sensitivity analysis identified the utility value for survivors with OUD, mortality risk in survivors with OUD, and combined survivorship/OUD-related costs as primary drivers of uncertainty in this model. However, in almost all scenarios of the sensitivity analysis, rapid opioid discontinuation remained dominant.

Conclusions: : High-dose therapy in disease-free cancer survivors is significantly cost-inefficient. High-dose therapy is associated with worse health outcomes and greater healthcare costs relative to low-dose therapy. Absent explicit clinical guidelines for tapering, opioid stewardship strategies for dose minimization in long-term survivorship care are critical for avoiding negative outcomes and preventing added costs.

Sponsorship:: None