Health care resource use and cost differences by opioid therapy type among chronic noncancer pain patients

Abstract

The study assessed 12-month chronic pain (CP)-related health care utilization and costs among chronic noncancer pain (CNCP) patients who initiated various long-term opioid treatments. Treatments included monotherapy with long-acting opioids (mono-LAOs), mono-therapy with short-acting opioids (mono-SAOs), both LAOs and SAOs (combination), and opioid therapy initiated with SAO or LAO and switched to the other class (switch). Using MarketScan^® claims databases (2006–2012), we identified CNCP patients with ≥90 days opioid supply after pain diagnosis and continuous enrollment 12 months before pain diagnosis (baseline period) and 12 months after opioid start (post-index period). Outcomes included CP-related health care utilization and costs. Among CNCP patients (n=21,203), the cohort distribution was 74% mono-SAOs, 22% combination, 2% mono-LAOs, and 2% switch. During follow-up, the average daily morphine equivalent dose was highest in mono-LAO patients (96.4 mg) compared with combination patients (89.8 mg), switch patients (64.3 mg), and mono-SAO patients (36.2 mg). After adjusting for baseline differences, the mono-LAO cohort had lower total CP-related costs ($4,933) compared with the mono-SAO ($8,604), switch ($10,470), and combination ($15,190) cohorts (all: P<0.05). Mono-LAO patients had greater CP-related prescription costs but lower medical costs than the other cohorts during the follow-up period, including lower CP-related hospitalizations (1% vs 11%–20%), emergency department visits (4% vs 11%–18%), and diagnostic radiology use (21% vs 54%–61%) (all: P<0.001). Use of pain-related medications and other treatment modalities was also significantly lower in the mono-LAO cohort relative to the other cohorts. CNCP patients using long-term monotherapy with LAOs had the lowest CP-related total health care costs in the 12 months after opioid initiation compared with mono-SAO, switch, or combination patients despite higher opioid daily doses and higher prescription costs. Future research accounting for severity and duration of pain would aid in determining the optimal long-term opioid regimen for CNCP patients.

Keywords:

• chronic pain
• long-acting opioids
• short-acting opioids
• health care claims
• database study

Acknowledgments

Funding for this research study was provided by Teva Pharmaceuticals. Bethany Sawchyn provided writing support for the manuscript. Editorial assistance was provided by Peloton Advantage and was funded by Teva Global Health Economics and Outcomes Research (Frazer, PA). Teva provided a full review of the article.

Data presented at the National Conference on Pain (PAIN-Week), September 8–12, 2015, Las Vegas, NV.

Disclosure

KG and PPY are employees of Teva Pharmaceuticals, Inc. RW was an employee of Teva Pharmaceuticals, Inc., at the time this research was conducted. PBL-B and AOD are employees of Xcenda, which has received research funding from Teva Pharmaceuticals, Inc., for the conduct of this study and for the preparation of this manuscript. SLC was an employee of Xcenda at the time this research was conducted; he is now an employee of Galaxy Informatica, Maharashtra, India. NK has received research funding and consulting fees from Teva Pharmaceuticals, Inc. The authors report no other conflicts of interest in this work.