Olufade Tope, Kong Amanda M, Princic Nicole, Juneau Paul, Kulkarni Rucha, Zhang Kui, Datto Catherine
Director, Health Economics & Outcomes Research, AstraZeneca, Wilmington, DE.
Research Leader, Truven Health Analytics, an IBM Company, Bethesda, MD.
Am Health Drug Benefits. 2017 Apr;10(2):79-86.
Constipation is a common adverse effect of opioid use and has been associated with increased healthcare utilization and costs among patients receiving opioids for pain management.
To compare the healthcare utilization and costs of Medicaid patients with chronic noncancer pain with and without constipation who were receiving opioids.
This retrospective, claims-based study was conducted using data from the Truven Health MarketScan Medicaid Multi-State database. Patients with no evidence of cancer who initiated opioid therapy between January 1, 2009, and June 30, 2013, were eligible for the study. Patients had to have continuous enrollment in the database in the 6 months before and 12 months after opioid initiation, with no evidence of substance abuse or functional or inflammatory bowel disease. Medical and pharmacy claims during the 12 months after opioid initiation were evaluated for a diagnosis of constipation or for prescription or over-the-counter medications indicative of constipation. All-cause healthcare utilization and costs were measured over the same period and were compared between propensity score-matched cohorts of patients with evidence of constipation and patients without constipation.
Of the 25,744 patients meeting the study inclusion criteria, 2716 (10.5%) had evidence of constipation. After 1:1 propensity score matching, the 2 cohorts had similar demographic and clinical characteristics (ie, mean age, 47 years; 26%-27% male). During the 12-month follow-up period, healthcare utilization was more frequent among patients with constipation, including inpatient admissions and emergency department visits, than in the matched patients without constipation. The total all-cause mean healthcare costs were substantially higher among the patients with constipation ($28,234; 95% confidence interval [CI], $24,307-$32,160) than in the patients without constipation ($13,709; 95% CI, $12,618-$14,801), with a median cost difference of $4166 per patient ( <.001).
Among Medicaid enrollees who receive opioids for chronic noncancer pain, constipation is associated with increased all-cause healthcare utilization and costs.
便秘是使用阿片类药物常见的不良反应，且与接受阿片类药物进行疼痛管理的患者医疗保健利用率增加和成本上升有关。
比较接受阿片类药物治疗的患有慢性非癌性疼痛的医疗补助患者中，有便秘和无便秘患者的医疗保健利用率及成本。
这项基于索赔数据的回顾性研究使用了Truven Health MarketScan医疗补助多州数据库中的数据。2009年1月1日至2013年6月30日期间开始阿片类药物治疗且无癌症证据的患者符合本研究条件。患者在开始使用阿片类药物前6个月和后12个月必须连续登记在数据库中，且无药物滥用或功能性或炎症性肠病的证据。对开始使用阿片类药物后12个月内的医疗和药房索赔进行评估，以诊断是否便秘或是否有指示便秘的处方或非处方药物。在同一时期测量全因医疗保健利用率和成本，并在倾向得分匹配的有便秘证据患者队列和无便秘患者队列之间进行比较。
在符合研究纳入标准的25744名患者中，2716名（10.5%）有便秘证据。经过1:1倾向得分匹配后，两个队列具有相似的人口统计学和临床特征（即平均年龄47岁；男性占26%-27%）。在12个月的随访期内，便秘患者的医疗保健利用率更高，包括住院和急诊就诊，高于匹配的无便秘患者。便秘患者的全因平均医疗保健总成本（28234美元；95%置信区间[CI]，24307美元至32160美元）显著高于无便秘患者（13709美元；95%CI，12618美元至14801美元），每位患者的成本中位数差异为4166美元（P<.001）。
在接受阿片类药物治疗慢性非癌性疼痛的医疗补助参保者中，便秘与全因医疗保健利用率增加和成本上升有关。
