Abstract
Background/ObjectivesAmong sickle cell disease (SCD) patients, vaso-occlusive crises (VOCs) are recurrent and unpredictable attacks of acute pain. These pain crises are often treated with analgesics, including opioids, which have been associated with misuse and overdose. The aim of this study was to examine the association between VOC events and opioid use and assess the association between opioid prescriptions and health care resource utilization among SCD patients.MethodsThis was a retrospective cohort study using Texas Medicaid medical and prescription claims between September 2011 and August 2016. The index date was the first SCD diagnosis. Patients (2–63 years) with at least one inpatient or two outpatient SCD diagnoses, who were continuously enrolled during 12 months postindex, were included in the study. The primary outcome was number of opioid prescriptions, while the independent variable was number of VOC events. Covariates included age, gender, nonopioid medication use, nonstudy SCD-related medication (penicillin and folic acid) use, evidence of blood transfusions, number of SCD-related complications, number of SCD-related comorbid conditions, and Charlson Comorbidity Index score. Negative binomial regression analysis was used to address study objectives.ResultsOf 3368 included patients, 1978 (58.7%) had at least one opioid prescription with a mean of 4.2 (SD=7.2). Overall, 2071 (61.5%) had at least one VOC event with an average of 2.9 (SD=4.4). The results from the negative binomial regression showed that for every increase in VOC events, the number of opioid prescriptions increased by 9.5% (Incidence rate ratio=1.095, 95% CI: 1.078–1.111; P ≤ 0.0001). Other significant covariates associated with higher opioid use included age (13 and older compared to 2–12) and increase in the number of nonopioid pain medications, nonstudy SCD-related medications, and SCD-related complications.ConclusionsThe majority of SCD patients had at least one VOC event and were prescribed opioids during the 12-month study period. We found that each VOC event was associated with a 9.5% increase in the use of opioids. SCD guidelines recommend opioids for the treatment of VOC-related pain. Payers and providers should be aware of opioid use in this population, consider appropriate VOC prevention measures, and provide SCD patients with access to appropriate pain management.
Highlights
Sickle cell disease (SCD), a rare inherited blood disorder characterized by a defect in the gene for hemoglobin, affects approximately 100 000 people in the United States (US).[1,2] Annual total expenditures for SCD-related emergency department (ED) visits and hospitalizations were estimated from a 2006 nationwide sample to be more than US$2.4 billion overall.[3]
The results from the negative binomial regression showed that for every increase in vaso-occlusive crisis (VOC) events, the number of opioid prescriptions increased by 9.5% (Incidence rate ratio=1.095, 95% CI: 1.078–1.111; P ≤ 0.0001)
We found that each VOC event was associated with a 9.5% increase in the use of opioids
Summary
Sickle cell disease (SCD), a rare inherited blood disorder characterized by a defect in the gene for hemoglobin, affects approximately 100 000 people in the United States (US).[1,2] Annual total expenditures for SCD-related emergency department (ED) visits and hospitalizations were estimated from a 2006 nationwide sample to be more than US$2.4 billion overall.[3] Total SCD-related medical expeditures for children were estimated to be US$335 million in 2005.4 The World Health Organization recognizes SCD as a societal health. These episodes of excruciating pain can be frequent and unexpected, with most SCD patients experiencing at least one VOC event in their lifetimes.[10,14,15,16] On average, people with SCD have more than six VOC hospitalizations per year, with an average length of stay ranging from 9 to 11 days for severe events.[17,18]
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