401P Fentanyl patch is the most common strong opioids in Taiwan cancer patients

Abstract

Aim/Background: Strong opioids are the cornerstone of cancer pain management. We examined the use of strong opioids among Taiwan cancer patients. Methods: By reviewing the claims database of National Health Insurance of Taiwan, we enrolled all patients who had cancer diagnosis (ICD-9: 140-208) from 2003 to 2011 with prescription of opioids in either inpatient or outpatient records. The prescription and costs of opioid analgesics were recorded. Opioids were classified to 3 groups (strong: morphine and fentanyl patches; weak: tramadol, buprenorphine, and codeine; others: propoxyphene, nalbuphine, and meperidine). We used WHO defined daily dose (DDD) to calculate the use of different opioids. Results: A total of 624,397 cancer patients who have used opioids were enrolled. The median age was 63 years, and 58% of them were male. Annually, 44.4% to 48.3% of patients had ever used strong opioids, which was stationary in the study period. Conversely, the percentage of patients who had ever used weak opioids increased from 52.1% in 2003 to 69.1% in 2011, and that of patients who had ever used other opioids decreased from 66.7% to 45.7%. Among strong opioid users, the percentage of patients who had ever used short-acting morphine increased (78.3% to 92.8%), and that of patients who had ever used fentanyl patches and long-acting morphine decreased (50.4% to 33.2% and 13.3% to 7.8%, respectively). Strong opioids contributed approximately 50% of the use of all opioids in cancer patients. Among the use of these strong opioids, that of the fentanyl patch was the highest but decreased from 60.0% in 2003 to 51.4% in 2011. The use of short-acting morphine increased from 29.4% to 38.5% among all strong opioids, but the use of long-acting morphine was stationary (~10%). The average annual cost of all opioids in cancer patients was 11.1 million USD, and 7.7 million (69%) of them were spent on strong opioids. The average annual costs of fentanyl patch, long-acting morphine, and short-acting morphine were 6.2 million, 0.6 million, and 0.9 USD, respectively. Conclusions: In Taiwan cancer patients, 50% of the opioids use came for strong opioids, and the fentanyl patch was the most commonly used strong opioids.