Medicines Policy Research Unit, Centre for Big Data Research in Health, UNSW, Sydney, New South Wales, Australia.
IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney (UTS), Sydney, New South Wales, Australia.
Asia Pac J Clin Oncol. 2021 Feb;17(1):68-78. doi: 10.1111/ajco.13408. Epub 2020 Sep 14.
Public subsidy of the oxycodone/naloxone controlled release (CR) combination in December 2011 expanded the overall market for oxycodone CR in the general public in Australia; we evaluate its impact in people with cancer.
We used Repatriation Pharmaceutical Benefits dispensing data linked with the NSW Cancer Registry for Department of Veterans' Affairs (DVA) healthcare card holders 65 years and older residing in NSW between 2004 and 2013 to identify clients with cancer and their opioid dispensings. We used interrupted time series analysis to model changes in monthly rates of oxycodone CR tablets dispensed and initiations. We performed a retrospective cohort study to examine changes in client characteristics and opioid utilization over time by comparing clients initiating oxycodone CR before and after subsidy.
The rate of oxycodone CR tablets dispensed/month increased by 20% from December 2011, due to uptake of the oxycodone/naloxone CR combination; monthly initiations increased immediately by 17%. Initiations of buprenorphine, fentanyl, and morphine declined from December 2011. DVA healthcare card holders were significantly more likely to initiate the 5 mg oxycodone CR formulation; more likely to use immediate release oxycodone in the 90 days following initiation; and less likely to use a weak opioid in the 90 days preceding oxycodone CR initiation following December 2011 than they were prior to that time.
The public subsidy of the oxycodone/naloxone CR formulation expanded the overall oxycodone CR market for DVA healthcare card holders with cancer. Our findings highlight the need for updated guidelines around risk management for opioid treatment in patients with cancer.
2011 年 12 月，对羟考酮/纳洛酮控释（CR）联合制剂的公共补贴扩大了澳大利亚普通人群中羟考酮 CR 的总体市场；我们评估了其对癌症患者的影响。
我们使用 Repatriation Pharmaceutical Benefits 配药数据，结合新南威尔士州退伍军人事务部（DVA）医疗保健卡持有者在 2004 年至 2013 年期间在新南威尔士州的 NSW 癌症登记处，确定患有癌症的患者及其阿片类药物的配药情况。我们使用中断时间序列分析来模拟每月羟考酮 CR 片的配药率和起始率的变化。我们进行了回顾性队列研究，通过比较补贴前后开始使用羟考酮 CR 的患者，来研究随时间推移患者特征和阿片类药物使用的变化。
自 2011 年 12 月以来，由于羟考酮/纳洛酮 CR 联合制剂的应用，羟考酮 CR 片剂的配药率每月增加了 20%；每月起始量立即增加了 17%。自 2011 年 12 月以来，丁丙诺啡、芬太尼和吗啡的起始量下降。与补贴前相比，DVA 医疗保健卡持有者更有可能开始使用 5mg 羟考酮 CR 制剂；在开始使用羟考酮 CR 的 90 天内，更有可能使用即释羟考酮；在开始使用羟考酮 CR 之前的 90 天内，使用弱阿片类药物的可能性更小。
羟考酮/纳洛酮 CR 制剂的公共补贴扩大了癌症 DVA 医疗保健卡持有者的羟考酮 CR 总体市场。我们的发现强调了需要更新癌症患者阿片类药物治疗风险管理指南。
