Objective: To compare the effects of tapentadol-extended release versus oxycodone-controlled release for pain relief on productivity by combining evidence from different sources.
Methods: Multiparameter evidence synthesis. Three sources were used. The first consisted of 3 randomized double-blind controlled trials that evaluated the efficacy and safety of tapentadol and oxycodone for the management of chronic pain. The second was published data on the incidence of constipation in patients exposed to opioids, and the third was a published survey that evaluated the effect of opioid-induced constipation on productivity. In the trials, a patient was classified as constipated if constipation was reported at any time during the 15 weeks of double-blinded assessment after randomization. In the survey, the effect of constipation on productivity was measured using the Work Productivity and Activity Impairment Questionnaire. All analyses were performed using Bayesian Markov chain Monte Carlo simulations in WinBUGS.
Results: The odds of developing constipation were 60% lower with tapentadol than with oxycodone (odds ratio=0.40, 95% credible interval, 0.32-0.50). Tapentadol was associated with less time missed from work, less impairment while working, and a lower overall loss in work productivity compared with oxycodone. The gain in overall work productivity with tapentadol was 1.92% compared with oxycodone (95% credible interval, 1.32-2.59), which translates to a gain of almost 1 hour per week worked.
Discussion: Tapentadol was associated with increases in all productivity dimensions compared with oxycodone. Multiparameter evidence synthesis capitalizes on available evidence, so that better informed medical decisions can be made.