(441) Healthcare utilization and cost differences in chronic non-cancer pain (CNCP) patients treated long-term with long-acting (LAOs), short-acting (SAOs), both, or with opioid therapy

Abstract

A retrospective, cohort analysis comparing 12-month chronic-pain (CP)-related healthcare utilization and costs among adult CNCP patients initiating different long term opioid treatments - monotherapy LAOs, monotherapy SAOs, both (LAOs with SAOs), and opioid switchers - was conducted. Using MarketScan® claims databases (2006-2012) CNCP patients with ≥90 days’ opioid supply after pain diagnosis, continuous enrollment 12 months prior to pain diagnosis (pre-period) and 12 months after opioid start (post-index) were identified. ANOVA and Kruskal-Wallis tests comparing continuous measures and chi-square and Fisher’s exact tests comparing categorical measures were employed. CNCP patients (n=21,205) were 52.7 (SD 14.7) years and 51.2% female, with cohort distribution 74% mono-SAOs, 22% both, 2% mono-LAOs, and 2% switch having mean opioid supply 240-285 days post-index. In the pre-period mono-LAOs had a greater Charlson comorbidity index (0.96 vs. 0.81-0.61), greater rate of drug abuse/dependence diagnosis (14.3% vs. 4.2-1.3%), and lower NSAIDS/acetaminophen, muscle relaxant, and corticosteroid use, all p<0.001; mono-SAOs had lower antidepressant and anticonvulsant use. Average daily dose (morphine mg equivalents) was highest in mono-LAOs (96.4 mg) compared to both (89.8 mg), switchers (64.3 mg), and mono-SAO (36.2 mg). Post-index epidural, physical therapy, nerve block, TENS, trigger point injection, and intrathecal drug therapy use were similar for mono-SAOs, both, and switchers and 2.5 times greater than mono-LAOs. Significantly greater CP-related hospitalizations (11-20% vs 1%), ER visits (11-18% vs 4%), and diagnostic radiology use (54-61% vs 21%) than mono-LAOs were also observed, all p<0.001. Mono-LAOs had greater post-index CP-related prescription costs ($2,748), driven by opioid costs, but significantly lower medical and therefore lower total CP-related costs: mono-LAOs ($4,263), mono-SAOs ($9,079), switchers ($9,911), and both ($15,405). CNCP long-term mono-LAOs had the highest opioid daily dose and opioid costs but lower rates of other CP-related medications and medical services resulting in the lowest CP-related healthcare costs in the 12-months post-opioid initiation. Study funded by Teva Pharmaceuticals.