Curtis Lesley H, Stoddard Jennifer, Radeva Jasmina I, Hutchison Steve, Dans Peter E, Wright Alan, Woosley Raymond L, Schulman Kevin A
Center for Clinical and Genetic Economics, Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715, USA.
Health Serv Res. 2006 Jun;41(3 Pt 1):837-55. doi: 10.1111/j.1475-6773.2006.00511.x.
To measure geographic variation in opioid use in a large, commercially insured, outpatient population in the United States.
Outpatient prescription drug claims database of a national pharmaceutical benefit manager for 7,873,337 subjects with at least one prescription drug claim in 2000.
We measured the period prevalence of claims for opioid analgesics and controlled-release oxycodone at the state level. We measured geographic variation using the weighted coefficient of variation and systematic component of variation. In county-level multivariable regression, we explored associations between potential explanatory variables and claims for opioid analgesics and controlled-release oxycodone.
A total of 567,778 (64.2 per 1,000 total claims) were for oral opioid analgesics. Claim rates by state ranged from <20 to >100 claims per 1,000 total claims. States with long-standing prescription monitoring programs had among the lowest rates. In the county-level data, presence of a statewide prescription monitoring program and proportions of the population aged 15-24 and 65 years and older were independently and negatively associated with claim rates for all opioid analgesics. Surgeons per 1,000, proportion of the population reporting illicit drug use, and proportion who were female were independently and positively associated with claim rates for all opioid analgesics. Only the proportion of the population aged 25-34 and number of surgeons per 1,000 were independently and positively associated with claim rates for oxycodone.
Claim rates for opioid analgesics vary significantly by state. Presence of a statewide prescription monitoring program is associated with lower claim rates at the county level. Future research should use individual-level data to assess whether these findings reflect a reduction in abuse and diversion or suboptimal treatment of pain.
在美国一个大型商业保险门诊人群中测量阿片类药物使用的地理差异。
一家全国性药品福利管理机构的门诊处方药索赔数据库，涉及2000年至少有一次处方药索赔的7873337名受试者。
我们在州层面测量了阿片类镇痛药和缓释羟考酮的索赔期间患病率。我们使用加权变异系数和变异的系统成分来测量地理差异。在县级多变量回归中，我们探讨了潜在解释变量与阿片类镇痛药和缓释羟考酮索赔之间的关联。
共有567778例（每1000例总索赔中64.2例）为口服阿片类镇痛药索赔。各州的索赔率范围为每1000例总索赔中<20例至>100例。拥有长期处方监测计划的州索赔率最低。在县级数据中，全州处方监测计划的存在以及15 - 24岁和65岁及以上人口的比例与所有阿片类镇痛药的索赔率独立且呈负相关。每1000人中的外科医生数量、报告使用非法药物的人口比例以及女性比例与所有阿片类镇痛药的索赔率独立且呈正相关。只有25 - 34岁人口的比例和每1000人中的外科医生数量与羟考酮的索赔率独立且呈正相关。
阿片类镇痛药的索赔率因州而异。全州处方监测计划的存在与县级较低的索赔率相关。未来的研究应使用个体层面的数据来评估这些发现是否反映了滥用和转移的减少或疼痛治疗的不充分。
