Department of Pharmaceutical Systems & Policy, Robert C. Byrd Health Sciences Center, West Virginia University School of Pharmacy , Morgantown , WV , USA.
Teva Pharmaceutical Industries , Frazer , PA , USA.
J Med Econ. 2019 Nov;22(11):1192-1201. doi: 10.1080/13696998.2019.1658590. Epub 2019 Sep 9.
To examine associations of opioid use and pain interference with activities (PIA), healthcare resource utilization (HRU) and costs, and wage loss in noninstitutionalized adults with osteoarthritis in the United States (US). Adults with osteoarthritis identified from the Medical Expenditure Panel Survey for 2011/2013/2015 were stratified by no-opioid use with no/mild PIA, no-opioid use with moderate/severe PIA, opioid use with no/mild PIA, and opioid use with moderate/severe PIA. Outcomes included annualized total HRU, direct healthcare costs, and wage loss. Multivariable regression analyses were used for comparisons versus no-opioid use with no/mild PIA (referent). The counterfactual recycled prediction method estimated incremental costs. Results reflect weighted nationally representative data. Of 4,921 participants (weighted = 20,785,007), 46.5% had no-opioid use with no/mild PIA; 23.2% had no-opioid use with moderate/severe PIA; 9.6% had opioid use with no/mild PIA; and 20.7% had opioid use with moderate/severe PIA. Moderate/severe PIA and/or opioid use were associated with significantly higher HRU and associated costs, and wage loss. Relative to adults with no/mild PIA, opioid users with moderate/severe PIA were more likely to have hospitalizations, specialist visits, and emergency room visits (all < .001). Relative to the referent, opioid use with no/mild PIA had higher per-patient incremental annual total healthcare costs ($11,672, 95% confidence interval [CI] = $11,435-$11,909) and wage loss ($1,395, 95% CI = $1,376-$1,414) as did opioid use with moderate/severe PIA ($13,595, 95% CI = $13,319-$13,871; and $2,331, 95% CI = $2,298-$2,363) (all < .001). Compared with the referent, estimated excess national total healthcare costs/lost wages were $23.3 billion/$1.3 billion for opioid use with no/mild PIA, and $58.5 billion/$2.2 billion for opioid use with moderate/severe PIA. Unobservable/unmeasured factors that could not be accounted for. Opioid use with moderate/severe PIA had significantly higher HRU, costs, and wage loss; opioid use was more relevant than PIA to the economic burden. These results suggest unmet needs for alternative pain management strategies.
为了研究在美国非住院的骨关节炎成年人中，阿片类药物的使用和疼痛干扰活动（PIA）与医疗资源利用（HRU）和成本以及工资损失之间的关联。从 2011/2013/2015 年的医疗支出面板调查中确定患有骨关节炎的成年人，根据无阿片类药物使用且 PIA 为无/轻度、无阿片类药物使用且 PIA 为中度/重度、阿片类药物使用且 PIA 为无/轻度和阿片类药物使用且 PIA 为中度/重度进行分层。结果包括年化总 HRU、直接医疗保健成本和工资损失。与无阿片类药物使用且 PIA 为无/轻度（参照）相比，使用多变量回归分析进行比较。反事实再循环预测方法估计了增量成本。结果反映了加权的全国代表性数据。在 4921 名参与者（加权 20785007 人）中，46.5%的人无阿片类药物使用且 PIA 为无/轻度；23.2%的人无阿片类药物使用且 PIA 为中度/重度；9.6%的人阿片类药物使用且 PIA 为无/轻度；20.7%的人阿片类药物使用且 PIA 为中度/重度。中度/重度 PIA 和/或阿片类药物的使用与更高的 HRU 和相关成本以及工资损失显著相关。与 PIA 为轻度/无的成年人相比，阿片类药物使用者中 PIA 为中度/重度的人更有可能住院、看专科医生和去急诊室（均 <.001）。与参照相比，阿片类药物使用且 PIA 为轻度/无的患者每年的总医疗保健成本（11672 美元，95%置信区间 [CI] = 11435-11909）和工资损失（1395 美元，95% CI = 1376-1414）更高，PIA 为中度/重度的阿片类药物使用也是如此（13595 美元，95% CI = 13319-13871；2331 美元，95% CI = 2298-2363）（均<.001）。与参照相比，估计阿片类药物使用且 PIA 为轻度/无的全国总医疗保健成本/工资损失增加额为 233 亿美元/13 亿美元，阿片类药物使用且 PIA 为中度/重度的全国总医疗保健成本/工资损失增加额为 585 亿美元/22 亿美元。不可观察/无法测量的因素无法考虑在内。PIA 为中度/重度的阿片类药物使用具有更高的 HRU、成本和工资损失；阿片类药物的使用比 PIA 更能影响经济负担。这些结果表明，替代疼痛管理策略存在未满足的需求。
