IBM Watson Health, Bethesda, Maryland.
IBM Watson Health, Cambridge, Massachusetts, USA.
Pain Med. 2019 Oct 1;20(10):1907-1918. doi: 10.1093/pm/pnz085.
This research compared health care resource use (HCRU) and costs for pharmacotherapy prescribing that was adherent vs nonadherent to published pain management guidelines. Conditions included osteoarthritis (OA) and gout (GT) for nociceptive/inflammatory pain, painful diabetic peripheral neuropathy (pDPN) and post-herpetic neuralgia (PHN) for neuropathic pain, and fibromyalgia (FM) for sensory hypersensitivity pain.
This retrospective cohort study used claims from MarketScan Commercial and Medicare Databases identifying adults newly diagnosed with OA, GT, pDPN, PHN, or FM during July 1, 2006, to June 30, 2013, with 12-month continuous coverage before and after initial (index) diagnosis. Patients were grouped according to their pharmacotherapy pattern as adherent, nonadherent, or "unsure" according to published pain management guidelines using a claims-based algorithm. Adherent and nonadherent populations were compared descriptively and using multivariate statistical analyses for controlling bias.
Final cohort sizes were 441,465 OA, 76,361 GT, 10,645 pDPN, 4,010 PHN, and 150,321 FM, with adherence to guidelines found in 51.1% of OA, 25% of GT, 59.5% of pDPN, 54.9% of PHN, and 33.5% of FM. Adherent cohorts had significantly (P < 0.05) fewer emergency department (ED) visits and lower proportions with hospitalizations or ED visits. Mean health care costs increased following diagnosis across all conditions; however, adherent cohorts had significantly lower increases in adjusted costs pre-index to postindex (OA $5,286 vs $9,532; GT $3,631 vs $7,873; pDPN $9,578 vs $16,337; PHN $2,975 vs $5,146; FM $2,911 vs $3,708; all P < 0.001; adherent vs nonadherent, respectively).
Adherence to pain management guidelines was associated with significantly lower HCRU and costs compared with nonadherence to guidelines.
本研究比较了符合和不符合已发布疼痛管理指南的药物治疗方案的医疗资源使用（HCRU）和成本。所涉及的病症包括：伤害感受性/炎症性疼痛的骨关节炎（OA）和痛风（GT）、神经性疼痛的痛性糖尿病周围神经病变（pDPN）和疱疹后神经痛（PHN）以及感觉过敏性疼痛的纤维肌痛（FM）。
本回顾性队列研究使用了 MarketScan 商业和医疗保险数据库中的索赔数据，纳入 2006 年 7 月 1 日至 2013 年 6 月 30 日期间初次（索引）诊断为 OA、GT、pDPN、PHN 或 FM 的成年人，在初始诊断前后有 12 个月的连续覆盖。根据已发布的疼痛管理指南，利用基于索赔的算法，根据患者的药物治疗模式将其分为符合、不符合或“不确定”用药方案。采用描述性分析和多变量统计分析对符合和不符合用药方案的人群进行比较，以控制偏倚。
最终队列规模分别为 441,465 例 OA、76,361 例 GT、10,645 例 pDPN、4,010 例 PHN 和 150,321 例 FM，符合指南的 OA 患者占 51.1%、GT 患者占 25%、pDPN 患者占 59.5%、PHN 患者占 54.9%、FM 患者占 33.5%。符合用药方案的患者（OA 组：急诊就诊次数显著减少（P<0.05），住院或急诊就诊比例更低。所有病症患者的医疗保健费用在诊断后均呈增加趋势；然而，符合用药方案的患者的调整后费用在指数前到指数后的增加幅度明显较低（OA 组：5,286 美元比 9,532 美元；GT 组：3,631 美元比 7,873 美元；pDPN 组：9,578 美元比 16,337 美元；PHN 组：2,975 美元比 5,146 美元；FM 组：2,911 美元比 3,708 美元；所有 P<0.001；分别与符合用药方案和不符合用药方案比较）。
与不符合指南相比，符合疼痛管理指南的药物治疗方案与更低的 HCRU 和成本相关。
