Gandhi Kavita, Wei Wenhui, Huang Ahong, Wang Li, Iyer Ravi, Katz Nathaniel P
Teva Pharmaceutical Industries, Frazer, PA, USA.
Regeneron Pharmaceuticals, Tarrytown, NY, USA.
Clinicoecon Outcomes Res. 2020 Jun 8;12:285-297. doi: 10.2147/CEOR.S244329. eCollection 2020.
Although opioids may be used in the management of pain in patients with osteoarthritis (OA), there is a dearth of real-world data characterizing opioid regimen failure in these patients.
Using claims data, this study explored measures that may be potentially indicative of opioid treatment failure and the association of such potential failure with health care resource utilization (HRU) and costs.
Using a national employer-sponsored insurance claims database covering the years 2011-2016, this retrospective longitudinal study identified adults with hip/knee osteoarthritis who filled ≥1 opioid prescription (index event) and had continuous health plan enrollment 6 months pre- and ≥12 months post-index. Index opioid regimen intensity was defined in the 3-month post-index period by frequency, average daily dose, and duration of action. Possible index opioid regimen failure was defined as an increase in opioid regimen intensity, addition of a non-opioid pain medication, joint surgery, or opioid-abuse-related events. One-year follow-up HRU and costs were compared between those with possible treatment failure and those without.
Among 271,512 OA patients (61.5% knee; 11.1% hip; 27.4% both), 34.9% met the definition of possible index opioid regimen failure within a year: increased regimen intensity (16.1%), joint surgery (14.0%), addition of non-opioid pain medication (11.4%), and opioid-abuse-related events (1.9%). Rates of possible failure generally increased with higher index regimen intensity. Compared with those who did not fail, those who potentially failed their index treatment regimen had significantly higher HRU (<0.001), and all-cause ($36,699 vs $15,114) and osteoarthritis-related costs ($17,298 vs $1,967) (both <0.0001).
Among OA patients treated with opioids, approximately one-third may fail their index opioid regimen within a year and incur significantly higher HRU and costs than those without. Further research is needed to validate these findings with clinical outcomes.
尽管阿片类药物可用于治疗骨关节炎（OA）患者的疼痛，但缺乏关于这些患者阿片类药物治疗方案失败的真实世界数据。
本研究利用索赔数据，探索可能提示阿片类药物治疗失败的指标，以及这种潜在失败与医疗资源利用（HRU）和成本之间的关联。
本回顾性纵向研究使用了一个涵盖2011 - 2016年的全国性雇主赞助保险索赔数据库，确定了髋/膝骨关节炎成年患者，这些患者开具了≥1份阿片类药物处方（索引事件），且在索引事件前6个月和索引事件后≥12个月持续参加健康计划。索引阿片类药物治疗方案强度在索引事件后3个月内根据用药频率、日均剂量和作用持续时间进行定义。可能的索引阿片类药物治疗方案失败定义为阿片类药物治疗方案强度增加、添加非阿片类止痛药物、关节手术或与阿片类药物滥用相关的事件。比较了可能治疗失败患者和未失败患者的一年随访期内的HRU和成本。
在271,512例OA患者中（61.5%为膝骨关节炎；11.1%为髋骨关节炎；27.4%为髋膝均患），34.9%在一年内符合可能的索引阿片类药物治疗方案失败的定义：治疗方案强度增加（16.1%）、关节手术（14.0%）、添加非阿片类止痛药物（11.4%）以及与阿片类药物滥用相关的事件（1.9%）。可能失败的发生率通常随着索引治疗方案强度的增加而升高。与未失败的患者相比，索引治疗方案可能失败的患者HRU显著更高（<0.001），全因成本（36,699美元对15,114美元）和骨关节炎相关成本（17,298美元对1,967美元）也显著更高（均<0.0001）。
在接受阿片类药物治疗的OA患者中，约三分之一可能在一年内索引阿片类药物治疗方案失败，且与未失败患者相比，其HRU和成本显著更高。需要进一步研究以通过临床结局验证这些发现。
