Marrett Elizabeth, Kwong Winghan Jacqueline, Frech Feride, Qian Chunlin
Daiichi Sankyo, Inc., Parsippany, NJ, USA.
, Spring, TX, USA.
Pain Ther. 2016 Dec;5(2):215-226. doi: 10.1007/s40122-016-0057-y. Epub 2016 Oct 4.
Nausea and vomiting (NV) are common side effects of opioid use and limiting factors in pain management. This study sought to quantify the frequency of antiemetic prescribing and the impact of NV on health care resource utilization and costs in outpatients prescribed opioids for acute pain. The perspective was that of a commercial health plan.
Medical and pharmacy claims from IMS PharMetrics Plus were used to identify patients initiating opioid therapy with a prescription for an oxycodone-, hydrocodone- or codeine-containing immediate-release product for acute use (≤15-day supply) between October 1, 2013 and September 30, 2014. Patients with a medical claim for NV (International Classification of Diseases, Ninth Revision, Clinical Modification codes 787.0x), with or without an antiemetic prescription fill, were compared with patients with no NV claim or antiemetic prescription fill to assess differences in all-cause health care utilization and costs over 1 month. Propensity score matching (PSM) was used to adjust for between-group differences in baseline patient characteristics.
The co-prescribing of opioids with antiemetic agents was 10.2%. After PSM (n = 45,790 per group), patients with NV claims had significantly more hospitalizations (11.5% vs 4.2%), emergency department visits (65.0% vs 12.1%), and physician office visits (85.2% vs 64.5%) compared with patients with no NV claims (all P < 0.0001). Mean total health care costs were higher among patients with a NV claim versus those without evidence of the side effect ($6290 vs $2309; P < 0.0001). Among patients with a recent hospitalization, patients with NV claims had higher rates of 30-day rehospitalization than those with no NV claims (24.4% vs 3.0%; P < 0.0001).
Among outpatients prescribed opioids for management of acute pain, co-prescribing with antiemetics was low, and the economic burden associated with NV was high. Efforts to prevent NV in patients receiving opioid therapy may improve patient outcomes and provide cost savings to the health care system.
Daiichi Sankyo, Inc.
恶心和呕吐（NV）是使用阿片类药物常见的副作用，也是疼痛管理中的限制因素。本研究旨在量化开具止吐药的频率，以及NV对开具阿片类药物治疗急性疼痛的门诊患者医疗资源利用和成本的影响。研究视角为商业健康保险计划。
利用IMS PharMetrics Plus的医疗和药房理赔数据，确定2013年10月1日至2014年9月30日期间开始接受阿片类药物治疗的患者，这些患者开具了含羟考酮、氢可酮或可待因的速释产品用于急性疼痛治疗（供应≤15天）。将有NV医疗理赔记录（国际疾病分类第九版临床修订版代码787.0x）的患者（无论是否开具了止吐药）与无NV理赔记录或未开具止吐药的患者进行比较，以评估1个月内全因医疗利用和成本的差异。倾向得分匹配（PSM）用于调整组间患者基线特征的差异。
阿片类药物与止吐药的联合开具率为10.2%。经过PSM（每组n = 45,790）后，与无NV理赔记录的患者相比，有NV理赔记录的患者住院率显著更高（11.5%对4.2%）、急诊就诊率显著更高（65.0%对12.1%）、医生门诊就诊率显著更高（85.2%对64.5%）（所有P < 0.0001）。有NV理赔记录的患者的平均总医疗成本高于无该副作用证据的患者（6290美元对2309美元；P < 0.0001）。在近期住院的患者中，有NV理赔记录的患者30天再住院率高于无NV理赔记录的患者（24.4%对3.0%；P < 0.0001）。
在开具阿片类药物治疗急性疼痛的门诊患者中，与止吐药的联合开具率较低，且与NV相关的经济负担较高。预防接受阿片类药物治疗患者的NV的努力可能会改善患者预后，并为医疗保健系统节省成本。
第一三共株式会社
