Economic evaluation of the randomised, double-blind, placebo-controlled study of subcutaneous ketamine in the management of chronic cancer pain

McCaffrey, N; Flint, T; Kaambwa, B; Fazekas, B; Rowett, D; Currow, DC; Hardy, J; Agar, MR; Quinn, S; Eckermann, S

Economic evaluation of the randomised, double-blind, placebo-controlled study of subcutaneous ketamine in the management of chronic cancer pain

McCaffrey, N Flint, T Kaambwa, B Fazekas, B Rowett, D Currow, DC

Hardy, J Agar, MR

Quinn, S Eckermann, S

Permalink

Publication Type:: Journal Article
Citation:: Palliative Medicine, 2019, 33 (1), pp. 74 - 81
Issue Date:: 2019-01-01

Closed Access

	Filename	Description	Size
	Economic evaluation of the randomised, double-blind, placebo-controlled study of subcutaneous ketamine in the management of chronic cancer pain.pdf	Published Version	317.86 kB	Adobe PDF	View/Open

Copyright Clearance Process

Recently Added
In Progress
Closed Access

This item is closed access and not available.

Full metadata record

Field	Value	Language
dc.contributor.author	McCaffrey, N	en_US
dc.contributor.author	Flint, T	en_US
dc.contributor.author	Kaambwa, B	en_US
dc.contributor.author	Fazekas, B	en_US
dc.contributor.author	Rowett, D	en_US
dc.contributor.author	Currow, DC https://orcid.org/0000-0003-1988-1250	en_US
dc.contributor.author	Hardy, J	en_US
dc.contributor.author	Agar, MR https://orcid.org/0000-0002-6756-6119	en_US
dc.contributor.author	Quinn, S	en_US
dc.contributor.author	Eckermann, S	en_US
dc.date.issued	2019-01-01	en_US
dc.identifier.citation	Palliative Medicine, 2019, 33 (1), pp. 74 - 81	en_US
dc.identifier.issn	0269-2163	en_US
dc.identifier.uri	http://hdl.handle.net/10453/135189
dc.description.abstract	© The Author(s) 2018. Background: Treating chronic, uncontrolled, cancer pain with subcutaneous ketamine in patients unresponsive to opioids and co-analgesics remains controversial, especially in light of recent evidence demonstrating ketamine does not have net clinical benefit in this setting. Aim: To evaluate the cost-effectiveness of subcutaneous ketamine versus placebo in this patient population. Design and setting: A within-trial cost-effectiveness analysis of the Australian Palliative Care Clinical Studies Collaborative’s randomised, double-blind, placebo-controlled trial of ketamine was conducted from a healthcare provider perspective. Mean costs and outcomes were estimated from participant-level data over 5 days including positive response, health-related quality of life (HrQOL) measured with the Functional Assessment of Chronic Illness Therapy–Palliative Care (FACIT-Pal), ketamine costs, medication usage and in-patient stays. Results: There was no statistically significant difference in responder rates, but higher toxicity and worse HrQOL for ketamine participants (mean change −3.10 (standard error (SE) 1.76), ketamine n = 93; 4.53 (SE 1.38), placebo n = 92). Estimated total mean costs were AU$706 higher per ketamine participant (AU$6608) compared with placebo (AU$5902), attributable to the cost of higher in-patient costs as well as costs of ketamine administration. The results were robust to sensitivity analyses accounting for different medication use costing methods and removal of cost outliers. Conclusion: The findings suggest subcutaneous ketamine in conjunction with opioids and standard adjuvant therapy is neither an effective nor cost-effective treatment for refractory pain in advanced cancer patients.	en_US
dc.relation.ispartof	Palliative Medicine	en_US
dc.relation.isbasedon	10.1177/0269216318801754	en_US
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject.classification	Gerontology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Ketamine	en_US
dc.subject.mesh	Palliative Care	en_US
dc.subject.mesh	Administration, Cutaneous	en_US
dc.subject.mesh	Double-Blind Method	en_US
dc.subject.mesh	Random Allocation	en_US
dc.subject.mesh	Placebo Effect	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Chronic Pain	en_US
dc.subject.mesh	Saline Waters	en_US
dc.subject.mesh	Cancer Pain	en_US
dc.title	Economic evaluation of the randomised, double-blind, placebo-controlled study of subcutaneous ketamine in the management of chronic cancer pain	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	33	en_US
utslib.for	1115 Pharmacology and Pharmaceutical Sciences	en_US
utslib.for	1112 Oncology and Carcinogenesis	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1199 Other Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access	*
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	33	en_US

Abstract:

© The Author(s) 2018. Background: Treating chronic, uncontrolled, cancer pain with subcutaneous ketamine in patients unresponsive to opioids and co-analgesics remains controversial, especially in light of recent evidence demonstrating ketamine does not have net clinical benefit in this setting. Aim: To evaluate the cost-effectiveness of subcutaneous ketamine versus placebo in this patient population. Design and setting: A within-trial cost-effectiveness analysis of the Australian Palliative Care Clinical Studies Collaborative’s randomised, double-blind, placebo-controlled trial of ketamine was conducted from a healthcare provider perspective. Mean costs and outcomes were estimated from participant-level data over 5 days including positive response, health-related quality of life (HrQOL) measured with the Functional Assessment of Chronic Illness Therapy–Palliative Care (FACIT-Pal), ketamine costs, medication usage and in-patient stays. Results: There was no statistically significant difference in responder rates, but higher toxicity and worse HrQOL for ketamine participants (mean change −3.10 (standard error (SE) 1.76), ketamine n = 93; 4.53 (SE 1.38), placebo n = 92). Estimated total mean costs were AU$706 higher per ketamine participant (AU$6608) compared with placebo (AU$5902), attributable to the cost of higher in-patient costs as well as costs of ketamine administration. The results were robust to sensitivity analyses accounting for different medication use costing methods and removal of cost outliers. Conclusion: The findings suggest subcutaneous ketamine in conjunction with opioids and standard adjuvant therapy is neither an effective nor cost-effective treatment for refractory pain in advanced cancer patients.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/135189