PMS79 Burden and Cost-of-Disease in Chronic Osteoarthritis PAIN Patients Refractory to Standard of Care in Spain:Further Outcomes of the Opioids Study

Abstract

To determine the burden and cost-of-disease in moderate-to-severe chronic osteoarthritis (OA) pain patients refractory to standard analgesic treatment from the perspective of the National Health System (NHS) in Spain. Secondary analysis of a non-interventional, retrospective, longitudinal (48 months), multicenter study (OPIOIDS), using electronic medical records (EMR) of patients ≥18 years, with moderate-to-severe chronic OA pain (>3 months), refractory to standard care with at least NSAIDs plus opioids, sequential or concomitantly. Burden-of-disease included measurement of analgesia (11-NRS), cognitive functioning (MiniMental-State-Examination-MMSE-), basic-activities-of-daily-living (Barthel scale), severity (Charlson index) and frequency of comorbidities. Cost-of-disease accounted by healthcare resources utilization (HRU) and related-costs (year 2018). 13,317 EMRs were analyzed; mean age 70.9 (SD:14.7) years, 69.3% (95% CI:68.5%-70.1%) women, refractory (58.1% NSAID+weak opioid and 41.9% NSAID+strong opioid), accounting for 10.7% (10.5-10.8%) of chronic OA pain patients. Average comorbidities number was 2.9 (1.8), with a Charlson index of 1.8 (1.7). Pain decreased by 0.9 points (12.2%), cognitive impairment increased by 2.2 points (9.1%, with 4.3% more patients with cognitive deficits [MMSE<20]) and Barthel worsened by 0.4 points (0.5%, with 2.3% more patients with severe-to-total dependence [Barthel<60]) over a median treatment persistence of 195 (86-935) days. Healthcare cost was €7,350/patient (€7,193-€7,507 or €1,838/year). Because of greater HRU, healthcare cost was higher with strong than with weak opioids; €9,886 (€9,608-€10,164, €2,472/year) vs. €5,519 (€5,349-€5,689, €1,380/year), respectively, p<0.001. Cost of analgesia (16.0% of the total cost) was higher with strong than with weak opioids, 20% vs. 11%, respectively, p<0.001. In routine clinical practice in Spain, patients with moderate-to-severe OA chronic pain refractory to standard analgesic treatment with NSAIDs+opioids, reported modest reduction in pain, while presenting with considerable burden of comorbidities, cognitive impairment and level of dependency in a relatively short period of treatment. Consequently, healthcare costs significantly increased for the NHS particularly when strong opioids.