Utilisation patterns of oxycodone/naloxone combination versus oxycodone alone in a regional hospital

Abstract

Background: Progress in the study and treatment of pain continues as the incidence of pain for patients in hospital remains a significant burden. A novel opioid combination of oxycodone/ naloxone (Targin) was listed on the Queensland Hospital Formulary in March 2012. Previous studies have shown its potential to reduce hospital drug and labour costs due to proven reduction in laxative use. However, it is not known whether the introduction of this combination formula has affected the usage of analgesics and laxatives in our hospital. Aim: To explore usage patterns of oxycodone/naloxone combination (Targin) versus oxycodone alone (Oxycontin) and to determine the cost-effectiveness for the introduction of a new combination formula within the Townsville hospital. Method: Patients were identified and sequentially recruited if eligible according to the inclusion and exclusion criteria. Data was collected prospectively over a two month timeframe using the hospital's existing medication database and reports generated from drug storage and dispensing machines within the facility. Results: Of the 69 patients recruited, 33 and 36 were each prescribed and administered oxycodone/naloxone or oxycodone alone respectively. A difference in case mix was seen with 88% of patients prescribed the combination formula from surgical wards, compared to 33% for the standalone product (X2=21.2, P =<0.0001). A 33% decrease in laxative use was found in the population administered oxycodone/naloxone (X2=7.7, P = 0.005) with a total amount of additional analgesia almost double the comparator single agent group. A higher expenditure per patient for 48 hours treatment was observed with the combination treatment. Conclusion: This study shows that the combination of oxycodone/naloxone results in decreased laxative use and increased additional analgesia. A varied pattern of usage within The Townsville Hospital was observed with potential off-licence practice.