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In palliative care, although opioids play a vital role in pain management for patients with cancer, they cause opioid-induced constipation (OIC). Naldemedine is extensively used to treat OIC; however, its prophylactic administration at the initiation of opioid therapy is not currently reimbursed under the public health insurance system. Researchers at University of Tsukuba demonstrated that the prophylactic administration of naldemedine along with opioid treatment is a cost-effective strategy in cancer palliative care.

Tsukuba, Japan—Although opioids remain indispensable for pain relief in patients with advanced cancer, their use frequently results in OIC, which can substantially reduce the 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, the 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 healthcare system.

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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This study was supported by Japanese Society for Palliative Medicine (No.192)

Original Paper

Title of original paper:

Cost-effectiveness of prophylactic naldemedine for opioid-induced constipation in patients with cancer

Journal:

Journal of Palliative Medicine

DOI:

10.1177/10966218261440391

Correspondence

Assistant Professor OKUBO Reiko
Professor KONDO Masahide
Institute of Medicine, University of Tsukuba

Associate Professor KESSOKU Takaomi
International University of Health and Welfare

Related Link

Institute of Medicine