Use of Drug Claims Data and a Medication Risk Score to Assess the Impact of CYP2D6 Drug Interactions among Opioid Users on Healthcare Costs.

Pamela Dow,Kevin T Bain,Brian Cicali,Lucy I Darakjian,Jacques Turgeon,Veronique Michaud,Matt K Smith,Ravil Bikmetov,Malavika Deodhar

doi:10.3390/jpm11111174

Abstract

Cytochrome P450 2D6 (CYP2D6) activity is highly variable due to several factors, including genetic polymorphisms and drug-drug-gene interactions. Hydrocodone, oxycodone, codeine, and tramadol the most commonly prescribed CYP2D6-activated opioids for pain. However, the co-administration of CYP2D6 interacting drugs can modulate CYP2D6-medicated activation of these opioids, affecting drug analgesia, effectiveness, and safety, and can impact healthcare costs. A retrospective, observational cohort analysis was performed in a large (n = 50,843) adult population. This study used drug claims data to derive medication risk scores and matching propensity scores to estimate the effects of opioid use and drug-drug interactions (DDIs) on medical expenditures. 4088 individuals were identified as opioid users; 95% of those were prescribed CYP2D6-activated opioids. Among those, 15% were identified as being at risk for DDIs. Opioid users had a significant increase in yearly medical expenditure compared to non-opioid users ($2457 vs. $1210). In matched individuals, average healthcare expenditures were higher for opioid users with DDIs compared to those without DDIs ($7841 vs. $5625). The derived medication risk score was higher in CYP2D6 opioid users with interacting drug(s) compared to no DDI (15 vs. 12). Higher costs associated with CYP2D6 opioid use under DDI conditions suggest inadequate CYP2D6 opioid prescribing practices. Efforts to improve chronic opioid use in adults should reduce interacting drug combinations, especially among patients using CYP2D6 activated opioids.

Highlights

Chronic pain is prevalent in the U.S population [1,2]
Our objectives were to (1) describe and quantify the use of opioids and concomitant drugs known to interfere with opioid metabolism, (2) estimate healthcare costs associated with drug-drug interactions (DDIs) among patients using opioids, and (3) investigate the impact on the medication risk score (MRS)
Our results demonstrated that opioid users had higher CYP450 drug interaction burden score than the non-opioid group, and the difference was even more pronounced among Cytochrome P450 2D6 (CYP2D6) opioid users with DDIs vs. those with no DDIs

Summary

Introduction

Chronic pain is prevalent in the U.S population [1,2]. Studies conducted over the past two decades have estimated the prevalence of chronic pain to range from 10% to 60%, and sometimes as high as 80%, among adults (aged ≥ 18 years) [3,4,5,6,7]. Chronic pain is one of the most common reasons adults seek medical care, accounting for 15 to 20% of physician visits, and can lead to a dependence on opioids, poor health, and a reduced quality of life [1,13,14]. In 2017, more than 191 million opioid prescriptions were filled in the U.S, and prescriptions for opioids to treat chronic pain continue to rise dramatically [15,16,17,18]

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