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Medical resource use and costs among pain patients with potential opioid-tolerability issues

Noam Y. Kirson, PhD, Amie Shei, PhD, Howard G. Birnbaum, PhD, Rami Ben-Joseph, PhD, Edward Michna, MD


Objective: To estimate excess medical resource use and costs associated with prescription opioid (RxO) tolerability issues.

Design: This was an observational, retrospective analysis of deidentified administrative claims data.

Setting: The study included commercially insured patients treated in different healthcare settings captured in the Truven MarketScan claims database.

Patients: Patients aged 18-64 years initiating treatment with an RxO (index) and continuously treated with pain relievers over a 6-month period were selected. “Switchers” were patients who discontinued their index RxO and switched to non-RxO pain relievers <30 days post-index, and whose last pain reliever in the 6-month follow-up period was not an RxO. Such switching was considered a proxy for RxO-tolerability issues. “Continuous RxO users” were patients who remained on the index RxO for the follow-up period. Switchers and continuous RxO users were matched 1:1 on propensity score, baseline medical costs, index RxO days supply, and short-/long-acting index RxO.

Main Outcome Measures: Six-month follow-up medical resource use and costs were compared between matched switchers and continuous RxO users.

Results: A total of 10,704 pairs of switchers and continuous RxO users were matched. In the 6-month follow-up period, switchers had more outpatient (7.5 vs 6.8; p < 0.001) and inpatient (0.05 vs 0.04; p = 0.002) visits and longer inpatient stays (0.26 days vs 0.19; p = 0.006) compared to continuous RxO users. Switchers also had higher total medical costs ($4,522 vs $3,657; p < 0.001).

Conclusions: Switchers incur greater medical resource use and costs than similar patients continuously treated with their index RxO.



opioids, tolerability, side effects

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