Treatment profiles and costs of patients with chronic pain in the population setting

Figures & data

Table 1 Distribution of different active ingredients included in the study according to therapeutic groups and classification of the World Health organization analgesic ladder

WHO ladder	ATC	Active ingredient	Boxes	%	RRP	%
Stage type 1	N02BE01	Paracetamol	67,211	37.8%	204,215.94	14.1%
	M01AE01	Ibuprofen	26,612	15.0%	126,017.51	8.7%
	N02BB02	Sodium metamizol	9198	5.2%	22,764.70	1.6%
	M01AB05	Diclofenac	7715	4.3%	21,905.62	1.5%
	M01AE17	Dexketoprofen	7498	4.2%	50,342.20	3.5%
	M01AB16	Aceclofenac	5864	3.3%	46,906.17	3.2%
	M01AE02	Naproxen	3303	1.9%	21,230.60	1.5%
	N03AX16	Pregabalin	3274	1.8%	192,731.56	13.3%
	N03AX12	Gabapentin	2947	1.7%	121,063.44	8.3%
	M01AB01	Indomethacin	2660	1.5%	7347.14	0.5%
	M01AC06	Meloxicam	2494	1.4%	17,595.79	1.2%
	M01AH01	Celecoxib	1426	0.8%	52,961.64	3.6%
		Other (NSAID analgesics)	8688	4.9%	125,412.62	8.6%
Stage type 2	N02AX52	Tramadol (combinations)	9934	5.6%	61,292.78	4.2%
	N02AX02	Tramadol	8271	4.7%	151,615.23	10.4%
	N02BE51	Paracetamol (combinations)	3957	2.2%	9600.97	0.7%
	N02AA59	Codeine (combinations)	1690	1.0%	4849.84	0.3%
	N02BA51	Acetyl salicylic acid (combined)	646	0.4%	1630.41	0.1%
Stage type 3	N02AB03	Fentanyl	2857	1.6%	160,003.15	11.0%
	N02AE01	Buprenorphine	816	0.5%	38,037.71	2.6%
	N02AA01	Morphine	586	0.3%	10,176.38	0.7%
	N02AA05	Oxycodone	194	0.1%	3524.15	0.2%
	Total		177,841	100.0%	1,451,225.55	100.0%

Abbreviations: WHO, World Health Organization; ATC, Guidelines for ATC classification; NSAID, nonsteroidal anti-inflammatory drug; RRP, recommended retail price.

Table 2 Unit costs of health care resources and productivity losses from absenteeism

Health care resources and non-health resources	Unit costs (€)
Medical visits
Visit to GP	22.74
Visit to emergency service	115.23
Hospitalization (one day)	314.61
Specialist medical care (referral)	102.36
Additional tests
Laboratory tests	21.86
Conventional x-ray	18.14
Diagnostic/therapeutic tests	36.45
Pharmaceutical prescription	RRP
Work productivity
Cost per day of absenteeism	54.65

Note: Source of health care data: authors’ analytical accounts.

Abbreviations: GP, general practitioner; RRP, recommended retail price.

Table 3 General characteristics of the series studied and measures related to efficacy in analgesic stages

Study groups: analgesic step subjects, %	Type 1–2 17,747 (97.7%)	Type 3 410 (2.3%)	Total 18,157 (100.0%)	P value
Sociodemographic characteristics
Mean age, years	66.1 ± 11.3	70.5 ± 11.6	66.2 ± 11.3	<0.001
45–54 years	17.7%	11.2%	17.5%
55–64 years	29.5%	19.3%	29.3%
65–74 years	26.8%	28.0%	26.8%
75–84 years	20.7%	31.2%	21.0%
>84 years	5.3%	10.2%	5.4%	<0.001
Gender (women)	63.4%	74.9%	63.7%	<0.001
General comorbidity
Mean RUB/patient	3.0 ± 0.6	3.3 ± 0.6	3.0 ± 0.6	<0.001
1	2.2%	0.0%	2.2%
2	10.5%	4.1%	10.4%
3	75.0%	66.3%	74.8%
4	10.7%	23.9%	11.0%
5	1.5%	5.6%	1.6%	<0.001
Mean of episodes/patient	7.6 ± 3.9	10.6 ± 5.2	7.7 ± 3.9	<0.001
Mean Charlson index	0.7 ± 1.1	1.3 ± 1.4	0.7 ± 1.1	<0.001
Associated comorbidities
Arterial hypertension	50.6%	63.9%	50.9%	<0.001
Diabetes mellitus	20.1%	31.0%	20.4%	<0.001
Dyslipemia	45.3%	44.5%	45.2%	NS
Obesity	17.8%	18.7%	17.9%	NS
Active smokers	13.2%	10.3%	13.2%	NS
Alcoholism	2.0%	1.5%	1.9%	NS
Ischemic heart disease	8.4%	14.0%	8.5%	<0.001
Stroke	9.6%	14.7%	9.7%	<0.001
Cardiovascular events	16.4%	27.3%	16.7%	<0.001
Organic insufficiencies	10.2%	17.2%	10.3%	<0.001
Bronchial asthma	5.1%	7.1%	5.1%	0.039
COPD	6.5%	8.4%	6.6%	NS
Neuropathies	1.1%	2.9%	1.1%	0.002
Dementia (all types)	2.0%	2.5%	2.0%	NS
Depressive syndrome	20.7%	34.4%	21.0%	<0.001
Major diagnostic categories
Cancer pain	9.0%	19.0%	9.2%	<0.001
Neuropathic pain	29.7%	44.4%	30.0%	<0.001
Musculoskeletal pain	81.2%	78.5%	81.2%	NS
Other alterations	11.3%	6.8%	11.2%	0.003
Measures related to efficacy
Patients visiting pain units	2.0%	18.3%	2.4%	<0.001
Hospital admissions	17.8%	36.6%	18.2%	<0.001
Mean of active ingredients/patient	2.3 ± 1.3	4.5 ± 1.4	2.3 ± 1.4	<0.001
Mean of opiates/patient	0.2 ± 0.4	1.5 ± 0.5	0.3 ± 0.5	<0.001
Mean of hospital stays/patient	1.2 ± 5.5	2.0 ± 8.5	1.4 ± 6.4	<0.001

Abbreviations: RUB, resource utilization bands; COPD, chronic obstructive pulmonary disease; NS, not statistically significant.

Table 4 Relationship between efficacy (pain unit, hospital treatment) and major diagnostic categories relative to the study groups (analgesic treatment)

Characteristic pain unit	Present n = 439	Absent n = 17,772
Step type 1–2 (n, %)
Cancer pain	25 (1.6)	1577 (98.4)
Neuropathic pain	220 (4.2)	5058 (95.8)
Musculoskeletal pain	308 (2.2)	14,155 (97.9)
Other alterations	23 (1.1)	1990 (98.9)
Mean, %	2.3	97.7
Step type 3 (n, %)
Cancer pain	6 (7.6)	73 (92.4)
Neuropathic pain	41 (22.4)	142 (77.6)
Musculoskeletal pain	63 (19.3)	263 (80.7)
Other alterations	7 (25.0)	21 (75.0)
Mean, %	18.6	81.4
Hospital treatment	n = 3322	n = 14,889
Step type 1–2 (n, %)
Cancer pain	460 (28.7)	1142 (71.3)
Neuropathic pain	915 (17.3)	4363 (82.7)
Musculoskeletal pain	2565 (17.7)	11,898 (82.3)
Other alterations	332 (16.5)	1681 (83.5)
Mean, %	20.1	80.0
Step type 3 (n, %)
Cancer pain	34 (43.0)	45 (57.0)
Neuropathic pain	49 (26.8)	134 (73.2)
Musculoskeletal pain	120 (36.8)	206 (63.2)
Other alterations	11 (39.3)	17 (60.7)
Mean, %	36.5	63.5

Table 5 Costs model (average/unit) of the series studied according to the different analgesic stages

Study groups subjects, %	Type 1–2 17,747 (97.7%)	Type 3 410 (2.3%)	Total 18,157 (100.0%)	P value
Cost in primary care	1942.5 ± 1294.9	3719.6 ± 2280.1	1982.7 ± 1351.2	<0.001
Visits to GP	273.7 ± 216.6	459.5 ± 301.8	277.9 ± 220.6	<0.001
Clinical tests	121.9 ± 97.2	137.8 ± 114.2	122.3 ± 97.6	<0.001
X-rays	88.3 ± 90.1	103.3 ± 103.5	88.7 ± 90.4	<0.001
Additional tests	40.7 ± 63.3	60.9 ± 91.2	41.2 ± 64.2	<0.001
Referral to specialists	627.3 ± 504.4	992.7 ± 896.7	635.6 ± 519.4	<0.001
Pharmaceutical prescription	790.6 ± 866.4	1965.4 ± 1566.9	817.1 ± 905.2	<0.001
Cost in specialist care	464.9 ± 1864.9	1786.0 ± 4255.3	494.7 ± 1961.0	<0.001
Hospital stay	405.0 ± 1834.8	1649.0 ± 4225.9	433.1 ± 1930.6	<0.001
Emergencies	59.8 ± 117.7	137.0 ± 202.6	61.6 ± 120.8	<0.001
Total health care costs	2407.4 ± 2436.2	5505.6 ± 5046.4	2477.4 ± 2566.5	<0.001
Non-health care costs (days absenteeism)	279.5 ± 1423.6	258.5 ± 1578.4	279.0 ± 1427.2	NS
Total cost (health care and non-health care)	2686.9 ± 2794.3	5764.1 ± 5265.2	2756.4 ± 2909.5	<0.001

Note: Values expressed in Euros.

Abbreviations: GP, general practitioner; NS, not significant.

Table 6 Multiple linear regression model with association between variable undertreatment and costs

Variables of equation	Coefficient	95% CI
Dependent: total costs (€) [R^2= 0.09]
Constant*	3507	2626–4386
Age, years	10	−3–23
Gender, man versus woman	−148	−440–143
Charlson index*	975	868–1082
Undertreatment (yes versus no)	383	−69–836
Dependent: total costs (€) [R^2= 0.09]
Constant*	4.07	3697–4442
Age, years	−50	−55–44
Gender, man versus woman	−196	−319–73
Charlson index*	−29	−74–16
Undertreatment (yes versus no)	−138	−329–54
Dependent: total costs (€) [R^2= 0.15]
Constant*	−563	−1365–239
Age, years	60	48–71
Gender, man versus woman	48	−218–314
Charlson index*	1,004	906–1101
Undertreatment (yes versus no)	521	109–934

* Note: Statistical significance (the confidence interval does not include 0).

Abbreviations: CI, confidence interval; R², coefficient of determination of the model.