Kang Hyeun Ah, Barner Jamie C, Richards Kristin M, Bhor Menaka, Paulose Jincy, Kutlar Abdullah
The University of Texas at El Paso, School of Pharmacy, El Paso, TX.
The University of Texas at Austin, College of Pharmacy, Austin, TX.
J Health Econ Outcomes Res. 2020 Jun 26;7(1):94-101. doi: 10.36469/jheor.2020.13348. eCollection 2020.
BACKGROUND/OBJECTIVES: Among sickle cell disease (SCD) patients, vaso-occlusive crises (VOCs) are recurrent and unpredictable attacks of acute pain. These pain crises are often treated with analgesics, including opioids, which have been associated with misuse and overdose. The aim of this study was to examine the association between VOC events and opioid use and assess the association between opioid prescriptions and health care resource utilization among SCD patients.
This was a retrospective cohort study using Texas Medicaid medical and prescription claims between September 2011 and August 2016. The index date was the first SCD diagnosis. Patients (2-63 years) with at least one inpatient or two outpatient SCD diagnoses, who were continuously enrolled during 12 months postindex, were included in the study. The primary outcome was number of opioid prescriptions, while the independent variable was number of VOC events. Covariates included age, gender, nonopioid medication use, nonstudy SCD-related medication (penicillin and folic acid) use, evidence of blood transfusions, number of SCD-related complications, number of SCD-related comorbid conditions, and Charlson Comorbidity Index score. Negative binomial regression analysis was used to address study objectives.
Of 3368 included patients, 1978 (58.7%) had at least one opioid prescription with a mean of 4.2 (SD=7.2). Overall, 2071 (61.5%) had at least one VOC event with an average of 2.9 (SD=4.4). The results from the negative binomial regression showed that for every increase in VOC events, the number of opioid prescriptions increased by 9.5% (Incidence rate ratio=1.095, 95% CI: 1.078-1.111; ≤ 0.0001). Other significant covariates associated with higher opioid use included age (13 and older compared to 2-12) and increase in the number of nonopioid pain medications, nonstudy SCD-related medications, and SCD-related complications.
The majority of SCD patients had at least one VOC event and were prescribed opioids during the 12-month study period. We found that each VOC event was associated with a 9.5% increase in the use of opioids. SCD guidelines recommend opioids for the treatment of VOC-related pain. Payers and providers should be aware of opioid use in this population, consider appropriate VOC prevention measures, and provide SCD patients with access to appropriate pain management.
背景/目的：在镰状细胞病（SCD）患者中，血管闭塞性危机（VOCs）是急性疼痛的反复发作且不可预测的发作。这些疼痛危机通常用镇痛药治疗，包括阿片类药物，而阿片类药物与滥用和过量使用有关。本研究的目的是检查VOC事件与阿片类药物使用之间的关联，并评估阿片类药物处方与SCD患者医疗资源利用之间的关联。
这是一项回顾性队列研究，使用2011年9月至2016年8月期间得克萨斯州医疗补助计划的医疗和处方索赔数据。索引日期为首次SCD诊断日期。纳入研究的患者年龄在2至63岁之间，至少有一次住院或两次门诊SCD诊断，且在索引日期后的12个月内持续参保。主要结局是阿片类药物处方数量，自变量是VOC事件数量。协变量包括年龄、性别、非阿片类药物使用情况、非研究性SCD相关药物（青霉素和叶酸）使用情况、输血证据、SCD相关并发症数量、SCD相关合并症数量以及查尔森合并症指数评分。采用负二项回归分析来实现研究目标。
在纳入研究的3368例患者中，1978例（58.7%）至少有一次阿片类药物处方，平均处方数为4.2（标准差=7.2）。总体而言，2071例（61.5%）至少有一次VOC事件，平均次数为2.9（标准差=4.4）。负二项回归结果显示，VOC事件每增加一次，阿片类药物处方数量增加9.5%（发病率比=1.095，95%置信区间：1.078 - 1.111；P≤0.0001）。与较高阿片类药物使用相关的其他显著协变量包括年龄（13岁及以上与2至12岁相比）以及非阿片类止痛药、非研究性SCD相关药物和SCD相关并发症数量的增加。
在为期12个月的研究期间，大多数SCD患者至少有一次VOC事件并被开具了阿片类药物。我们发现，每一次VOC事件都与阿片类药物使用增加9.5%相关。SCD指南推荐使用阿片类药物治疗与VOC相关的疼痛。支付方和医疗服务提供者应了解该人群的阿片类药物使用情况，考虑适当的VOC预防措施，并为SCD患者提供适当的疼痛管理。
