Roberts Melissa H, Mapel Douglas W, Thomson Heather N
Lovelace Clinic Foundation, Albuquerque, NM, USA.
Endo Pharmaceuticals, Malvern, PA, USA.
Clinicoecon Outcomes Res. 2015 Mar 26;7:173-84. doi: 10.2147/CEOR.S80424. eCollection 2015.
To examine how pain affects health care utilization and direct medical costs in individuals with chronic obstructive pulmonary disease (COPD) compared to patients with other chronic diseases.
A retrospective cohort analysis using administrative data of a managed health care system in the Southwestern US for years 2006-2010.
COPD patients age ≥40 years were matched to similar patients with other chronic conditions on age, sex, insurance type, and a health care event (outpatient visit, emergency department visit, or inpatient stay). Chronic pain was indicated by pain-associated diagnoses and procedures, or fills for prescription pain medications. The study population was also stratified into those with and without chronic pain to examine clinical factors and costs associated with chronic pain.
Seven thousand nine hundred and fifty-two COPD patients (mean age 69 years, 58% women) were matched to 15,904 patients with other chronic disease. COPD patients had significantly higher utilization for pain-related services and for overall services. COPD patients had a higher prevalence of any pain medication use over a 12-month period (41.2% versus 31.5%) and, among those using pain medications, a higher mean number of pain medication prescription fills (10.1 versus 6.4). Factors associated with chronic pain included age 40-65 years, being female, having more than one chronic morbidity, insurance type, some emergency department or hospital utilization, and having either COPD, heart failure, arthritis, or stroke. Among COPD patients, those with chronic pain had a mean annual direct cost for overall utilization of $24,261 versus $10,390 among those without chronic pain (P<0.0001 for all comparisons).
COPD patients have substantially more utilization for pain medications and pain-related procedures than those with most other chronic diseases. Total direct medical costs among COPD patients who have chronic pain are more than double those of COPD patients without chronic pain. Pain management may be an opportunity for better and more cost-effective care for COPD patients.
与其他慢性疾病患者相比，研究疼痛如何影响慢性阻塞性肺疾病（COPD）患者的医疗服务利用情况及直接医疗费用。
采用美国西南部一个管理式医疗系统2006 - 2010年的管理数据进行回顾性队列分析。
年龄≥40岁的COPD患者在年龄、性别、保险类型及一次医疗事件（门诊就诊、急诊科就诊或住院）方面与患有其他慢性疾病的类似患者进行匹配。慢性疼痛通过与疼痛相关的诊断、治疗程序或处方止痛药的配药情况来表明。研究人群还被分为有慢性疼痛和无慢性疼痛两组，以研究与慢性疼痛相关的临床因素和费用。
7952例COPD患者（平均年龄69岁，58%为女性）与15904例其他慢性疾病患者进行了匹配。COPD患者在与疼痛相关的服务及总体服务方面的利用率显著更高。COPD患者在12个月内使用任何止痛药的患病率更高（41.2%对31.5%），且在使用止痛药的患者中，平均止痛药处方配药次数更多（10.1次对6.4次）。与慢性疼痛相关的因素包括年龄40 - 65岁、女性、患有不止一种慢性疾病、保险类型、一些急诊科或医院的就诊情况，以及患有COPD、心力衰竭、关节炎或中风。在COPD患者中，有慢性疼痛的患者总体利用的年均直接费用为24261美元，而无慢性疼痛的患者为10390美元（所有比较P<0.0001）。
与大多数其他慢性疾病患者相比，COPD患者在止痛药和与疼痛相关的治疗程序方面的利用率要高得多。有慢性疼痛的COPD患者的直接医疗总费用是无慢性疼痛的COPD患者的两倍多。疼痛管理可能是为COPD患者提供更好且更具成本效益的护理的一个契机。
