{
  "abstract": "Objectives To compare costs and health consequences and to assess the cost-effectiveness of using low-dose oral long-acting morphine in people with chronic breathlessness.Design Within-trial planned cost-consequences and cost-effectiveness analysis of data from a multisite, parallel-group, double-blind, randomised, placebo-controlled trial of low-dose, long-acting morphine.Setting 11 hospital outpatients across the UK.Participants Consenting adults with chronic breathlessness due to long-term cardiorespiratory conditions.Intervention 5–10 mg two times a day oral long-acting morphine with a blinded laxative for 56 days.Primary outcome measures Mean and SD of healthcare resource use (HRU) by trial arm; mean differences and 95% CI of costs between trial arms.Secondary outcome measures Mean differences in 28- and 56-day quality-adjusted life years (QALYs based on EuroQol five-dimension five-level score), Short Form-six dimensional scores and ICEpop CAPability-Supportive Care Measure scores; cost-utility of long-acting morphine for chronic breathlessness.Results 143 participants (75 morphine and 67 placebo) were randomised; 140 (90% power, males 66%, mean age 70.5 (SD 9.4)) formed the modified intention-to-treat population (participants receiving at least one dose of study medication). There were more inpatient and fewer outpatient services used by the morphine group versus the placebo. In the base-case analysis at 56 days, long-acting morphine was associated with similar mean per-patient costs and QALYs. There was an increase of £24 (95% CI −£395 to £552) and 0.002 (95% CI −0.004 to 0.008) QALYs. Hospitalisations were the main driver of cost differences. The corresponding incremental cost-effectiveness ratio was £12 000/QALY, with a probability of cost-effectiveness of 54% at a £20 000 willingness-to-pay threshold. In the scenario analysis that excluded costs of adverse events considered unrelated to long-acting morphine by site investigators and researchers, the probability of cost-effectiveness increased to 73%.Conclusion Oral morphine for chronic breathlessness is likely to be a cost-effective intervention provided adverse events are minimised, but the effect on outcome is small and cautious interpretation is warranted.Trial registration number ISRCTN87329095.",
  "authors": [
    {
      "affiliations": [
        "Edinburgh Clinical Trials Unit, The University of Edinburgh, Edinburgh, Scotland, UK"
      ],
      "name": "Marek Jan Atter"
    },
    {
      "affiliations": [
        "Cancer Research Centre, The University of Edinburgh, Edinburgh, Scotland, UK"
      ],
      "name": "Peter Hall"
    },
    {
      "affiliations": [
        "University of Leicester, Leicester, England, UK"
      ],
      "name": "Rachael A Evans"
    },
    {
      "affiliations": [
        "Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK"
      ],
      "name": "John Norrie"
    },
    {
      "affiliations": [
        "Hull Health Trials Unit, University of Hull, Hull, England, UK"
      ],
      "name": "Judith Cohen"
    },
    {
      "affiliations": [
        "Hull Health Trials Unit, University of Hull, Hull, England, UK"
      ],
      "name": "Bronwen Williams"
    },
    {
      "affiliations": [
        "School of Medicine, Department of Life and Health Sciences, Ulster University, Coleraine, Northern Ireland, UK"
      ],
      "name": "Nazia Chaudhuri"
    },
    {
      "affiliations": [
        "Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, King's College London, London, England, UK"
      ],
      "name": "Sabrina Bajwah"
    },
    {
      "affiliations": [
        "Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation, King's College London, London, England, UK"
      ],
      "name": "Irene Higginson"
    },
    {
      "affiliations": [
        "Hull York Medical School, University of Hull, Hull, England, UK"
      ],
      "name": "Mark Pearson"
    },
    {
      "affiliations": [
        "Flinders Ageing Alliance, Flinders University, Bedford Park, South Australia, Australia"
      ],
      "name": "David Currow"
    },
    {
      "affiliations": [
        "NHS Lothian, Edinburgh, Scotland, UK"
      ],
      "name": "Gareth Stewart"
    },
    {
      "affiliations": [
        "Cancer Research Centre, The University of Edinburgh, Edinburgh, Scotland, UK"
      ],
      "name": "Marie Fallon"
    },
    {
      "affiliations": [
        "Hull York Medical School, University of Hull, Hull, England, UK"
      ],
      "name": "Miriam Johnson"
    }
  ],
  "title": "Morphine for chronic breathlessness (MABEL) in the UK: a health economic evaluation of a multisite, parallel-group, dose titration, double-blind, randomised, placebo-controlled trial",
  "uid": "4ac7c66d-39cb-5ebe-a400-4b35a4a7251f"
}