Transdermal fentanyl patch versus subcutaneously infused morphine – A cost comparison

A cost model was developed to review the cost of transdermal fentanyl compared to the cost of ambulatory morphine infusion, and provide a model for future applications in similar settings. The model was based on the usual standard of care and service provided through the palliative care unit at PMCI and on current clinical practice. Costs based on the current wholesale price incurred by PMCI were identified on the basis of inpatient or outpatient status. Costs for external services were calculated on current market prices. Cost estimations were made on two doses of morphine, 30mg and 480mg per day A comparable dose of transdermal fentanyl to subcutaneous morphine was calculated based on the approved product information for DurogesicTM. Costs calculated in the comparison consisted of hardware and consumables (such as infusion device, syringes etc), and staff costs (doctors, nurses, pharmacists). The results showed, on an inpatient basis, the cost was marginally in favour of transdermal patches at the low dose, and in favour of the morphine infusion at the high dose. However, on an outpatient basis, the cost was clearly in favour of the transdermal fentanyl patches, costing 75% less at the low dose and 10% less at the high dose. The development of this model will enable evaluations to be made in a range of clinical scenarios.