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A rational and transparent method, System of Objectified Judgement Analysis (SOJA), for drug selection is described for selection of rapid acting fentanyl formulations for breakthrough pain in cancer-related pain. The relevant selection criteria for a group of drugs are defined and judged by a panel of experts. The more important that a selection criterion is considered, the higher the relative weight that is given to that criterion. The ideal properties for each selection criterion are determined and each drug is scored as a percentage of the relative weight for all selection criteria. Selection criteria (relative weight) were: number of available strengths (60), variability in rate of absorption (50), interactions (50), clinical efficacy (350), side-effects (150), ease of administration (140) and documentation (200). The sublingual fentanyl orally disintegrating tablet (Abstral) showed the highest overall score, followed by the nasal sprays (Instanyl and PecFent). These are the most attractive formulations from a formulary perspective.

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Robert Janknegt is working as hospital pharmacist and clinical pharmacologist at the Zuyderland Medical Centre in Sittard-Geleen, the Netherlands. His main research project is rational decisionmaking in selecting medicines from a formulary perspective by means of an interactive matrix model.

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