Sicras-Mainar Antoni, Tornero-Tornero Carlos, Vargas-Negrín Francisco, Lizarraga Isabel, Rejas-Gutierrez Javier
Health Economics and Outcomes Research, Real Life Data SLU. Edifici BCIN, Carrer Marcus Porcius, núm. 1, Polígon les Guixeres, Badalona, Barcelona 08915, Spain.
Department of Anesthesiology, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Ther Adv Musculoskelet Dis. 2020 Sep 17;12:1759720X20942000. doi: 10.1177/1759720X20942000. eCollection 2020.
The objective of this study was to analyze health outcomes, resource utilization, and costs in osteoarthritis patients with chronic nociceptive pain who began treatment with an opioid in real-world practice in Spain.
We designed a non-interventional, retrospective, longitudinal study with 36 months of follow-up using electronic medical records (EMRs) from primary care centers, of patients aged 18+ years who began a new treatment with an opioid drug in usual practice for chronic pain due to osteoarthritis. Health/non-health resource utilization and costs, treatment adherence, pain change, cognitive functioning, and dependence for basic activities of daily living (BADL) were assessed.
A total of 38,539 EMRs [mean age (SD); 70.8 (14.3) years, 72.3% female; 53.3% hip/knee, 25.0% spine, and 21.7% other sites] were recruited. A total of 19.1% of patients remained on initial opioid at 36 months, without significant differences by osteoarthritis site ( = 0.125). Mean total adjusted cost was €17,915, with 27.7% corresponding to healthcare resources and 72.3% to lost productivity. Hospital admissions for osteoarthritis-related surgical interventions accounted for 15.8% of total healthcare cost. A slight mean pain reduction was observed: -1.3 points, -16.9%, < 0.001, with increases in cognitive deficit (+3.3%, < 0.001) and moderate to total dependence for BADL (+15.6%, < 0.001) in a median duration of opioid use of 203 days (IQR: 89-696).
In real-world practice in Spain, opioid use in osteoarthritis was high, but with low adherence. There were meaningful increases in resource use and costs for the National Health System. Pain reduction was modest, whereas cognitive impairment and dependence for BADL increased significantly.
本研究的目的是分析在西班牙实际临床中开始使用阿片类药物治疗的慢性伤害性疼痛骨关节炎患者的健康结局、资源利用和成本。
我们设计了一项非干预性、回顾性纵向研究，利用基层医疗中心的电子病历（EMR）对年龄在18岁及以上、因骨关节炎慢性疼痛开始接受阿片类药物常规治疗的患者进行36个月的随访。评估了健康/非健康资源利用和成本、治疗依从性、疼痛变化、认知功能以及日常生活基本活动（BADL）的依赖性。
共纳入38539份电子病历[平均年龄（标准差）；70.8（14.3）岁，72.3%为女性；53.3%为髋/膝关节，25.0%为脊柱，21.7%为其他部位]。36个月时，共有19.1%的患者仍在使用初始阿片类药物，不同骨关节炎部位无显著差异（P = 0.125）。调整后的平均总成本为17915欧元，其中27.7%对应医疗资源，72.3%对应生产力损失。与骨关节炎相关手术干预的住院费用占总医疗费用的15.8%。观察到疼痛略有减轻：-1.3分，-16.9%，P < 0.001，在阿片类药物使用的中位持续时间为203天（四分位间距：89 - 696）时，认知缺陷增加（+3.3%，P < 0.001），BADL中度至完全依赖增加（+15.6%，P < 0.001）。
在西班牙的实际临床中，骨关节炎患者使用阿片类药物的比例较高，但依从性较低。国家卫生系统的资源使用和成本有显著增加。疼痛减轻程度较小，而认知障碍和BADL依赖性显著增加。
