Opioid analgesics are known to impact on the central nervous system (CNS). These CNS side effects, such as
dizziness and
confusion, have been shown to lead to an increased risk of falling with subsequent fractures in elderly patients being treated with
opioids. The risk of experiencing fractures has been shown to be dependent on the substance administered. Therefore, a health economic model was developed to investigate the cost-effectiveness of the most commonly used strong
opioids in Germany, focussing on
opioid-related fractures. By means of a Markov model, the consequences of hip, spine and forearm fractures due to the prior administration of transdermal (TD)
buprenorphine, TD
fentanyl, oral
oxycodone as well as oral
morphine were assessed from the perspectives of the German statutory health insurance (SHI) and the German social security (GSS) system over a time horizon of 6 years. The most frequently prescribed strength/package-size combinations of these
opioids were taken into consideration, including generics where available. The results of the present analysis predict that TD
buprenorphine is dominant compared to TD
fentanyl and
oxycodone by showing better effects [life years gained/quality adjusted life years (QALY) gained] at lower cost. From the SHI perspective, the incremental cost-effectiveness ratio (ICER) compared to
morphine is <euro> 6,801.61 per life year gained, and <euro> 7,766.11 per QALY gained. From the GSS perspective, the ICER is <euro> 2,496.77 per life year gained and <euro> 2,850.83 per QALY gained. The model is robust regarding probabilistic variations of all parameters in the sensitivity analyses. Focussing on fractures due to the prior administration of strong
opioids, TD
buprenorphine is less costly and more effective than TD
fentanyl and
oxycodone and represents a cost-effective treatment option versus
morphine in patients with
chronic pain from both the SHI and GSS perspective in Germany.