Johnson and Johnson Pharmaceutical Services, LLC, Raritan, NJ, USA.
Ann Pharmacother. 2010 Apr;44(4):630-40. doi: 10.1345/aph.1M520. Epub 2010 Mar 2.
Gastrointestinal (GI) adverse effects are common with oral opioid treatment.
To estimate the costs associated with GI events after oral short-acting opioid treatment, from the payer perspective.
Medical and pharmacy claims from the PharMetrics' Patient-Centric Database were used to identify opioid-naïve patients who received a new prescription for oxycodone- or hydrocodone-containing immediate-release oral products between 2002 and 2006. Health-care resource use and costs were determined for patients with claims associated with ICD-9 CM (International Classification of Diseases-9th Clinical Modification) codes for nausea/vomiting (787.0x), constipation (564.0x), bowel obstruction (560, 560.1, 560.3, 560.39, 564.81), or antiemetic and laxative prescriptions during the 3 months after opioid index prescription and compared with patients without these GI event medical or prescription claims. Resource use data were compared using negative binomial regression and cost data were compared using ordinary least squares confirmed by generalized gamma regression analysis while controlling for demographics, treatment duration, and comorbidities.
Data from 237,447 patients were analyzed. Patients with GI event claims had significantly more hospitalizations (adjusted mean 0.20 to 0.97 vs 0.17, respectively, p < 0.001), days in the hospital (1.12 to 12.05 vs 1.00 days, p < 0.001), emergency department visits (0.36 to 1.44 vs 0.25 visits, p < 0.001), outpatient office visits (5.68 to 11.81 vs 4.11 visits, p < 0.001), and prescription claims (7.46 to 8.21 vs 6.06 claims, p < 0.001) than did patients without any GI event claims in the 3 months after index opioid prescription. Compared with patients without any GI event claims, incremental adjusted mean total health-care costs for patients with any of the GI event claims ranged from $4,880 to $36,152 and were significant (p < 0.001).
The economic burden of GI events coincident with opioid treatment is significant for patients with a GI event recorded in claims. Reducing GI adverse effects has potential cost savings for the health-care system.
口服阿片类药物治疗会引起胃肠道（GI）不良反应。
从支付者的角度估算口服短效阿片类药物治疗后与 GI 事件相关的成本。
使用 PharMetrics 的患者为中心数据库中的医疗和药房索赔数据，确定在 2002 年至 2006 年期间接受新处方的含有羟考酮或氢可酮的即时释放口服产品的阿片类药物初治患者。确定与 ICD-9-CM（国际疾病分类第 9 版临床修订版）用于恶心/呕吐（787.0x）、便秘（564.0x）、肠梗阻（560、560.1、560.3、560.39、564.81）的代码相关的索赔患者的医疗保健资源使用和成本，并与没有这些 GI 事件医疗或处方索赔的患者进行比较。使用负二项回归比较资源使用数据，使用普通最小二乘法（通过广义伽马回归分析确认）比较成本数据，同时控制人口统计学、治疗持续时间和合并症。
分析了 237447 名患者的数据。有 GI 事件索赔的患者住院治疗明显更多（调整后平均值分别为 0.20 至 0.97 与 0.17，p<0.001）、住院天数（1.12 至 12.05 与 1.00 天，p<0.001）、急诊就诊（0.36 至 1.44 与 0.25 次就诊，p<0.001）、门诊就诊（5.68 至 11.81 与 4.11 次就诊，p<0.001）和处方索赔（7.46 至 8.21 与 6.06 次索赔，p<0.001）。与没有任何 GI 事件索赔的患者相比，有任何 GI 事件索赔的患者在阿片类药物指数处方后 3 个月内的总医疗保健成本的调整后平均增量为 4880 美元至 36152 美元，差异具有统计学意义（p<0.001）。
在记录了 GI 事件索赔的患者中，与阿片类药物治疗相关的 GI 事件的经济负担是显著的。减少 GI 不良反应可能会为医疗保健系统节省成本。
