Economic evaluation supports prophylactic naldemedine for opioid-induced constipation in cancer palliative care

Although opioids remain indispensable for pain relief in patients with advanced cancer, their use frequently results in OIC, which can substantially reduce quality of life and, in some cases, compromise the continuation of optimal pain management. Naldemedine, a peripherally acting μ-opioid receptor antagonist, is used to treat OIC by preserving physiological bowel motility without interfering with central analgesia.

Previous research has demonstrated that prophylactic administration of naldemedine at the start of opioid therapy can prevent constipation, improve constipation-related quality of life, and reduce associated symptoms such as nausea. However, as of 2025, the prophylactic use of naldemedine has not been reimbursed under the public health insurance system and is not yet established as standard care. Hence, an economic evaluation is necessary to support its widespread use.

In this study, researchers investigated the cost-effectiveness of prophylactic naldemedine use in patients with cancer initiating regularly scheduled strong opioid therapy for the first time. The analysis revealed that the incremental cost-effectiveness ratio—the additional cost required to gain one quality-adjusted life year (QALY)—was 1,445,276 Japanese yen per QALY gained. In Japan, the official willingness-to-pay threshold for health insurance coverage of new medical interventions is set at 5 million yen per QALY. These data indicate that prophylactic naldemedine use in palliative care is a cost-effective intervention within the Japanese health care system. The study is published in the Journal of Palliative Medicine.

The results provide robust economic evidence supporting the approval of prophylactic oral naldemedine as a reimbursable medical service in cancer palliative care and its potential inclusion in future clinical practice guidelines. Adoption of this approach may improve symptom control, support sustained opioid adherence, and facilitate more appropriate pain management for patients with cancer.

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Gaby Clark

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Andrew Zinin

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