, Health Economics & Outcomes Research, Medtronic Plc., 710 Medtronic Parkway, Minneapolis, MN, 55432, USA.
Department of Anesthesiology, Perioperative and Pain Medicine Brigham & Women's Hospital, Boston, USA.
Osteoporos Int. 2022 Apr;33(4):821-837. doi: 10.1007/s00198-021-06163-3. Epub 2021 Nov 2.
This retrospective analysis of insurance claims evaluated real-world trends in prescription fills among patients treated with balloon kyphoplasty (N = 6,656) or vertebroplasty (N = 2,189) following diagnosis of vertebral compression fracture. Among those with evidence of opioid use, nearly half of patients discontinued or reduced prescription fills relative to pre-operative levels.
Vertebral compression fractures (VCF) are associated with debilitating pain, spinal misalignment, increased mortality, and increased healthcare-resource utilization in elderly patients. This study evaluated the effect of balloon kyphoplasty (BKP) or vertebroplasty (VP) on post-procedure opioid prescription fills and payer costs in patients with VCF.
This was a retrospective analysis of a large, nationally representative insurance-claims database. Clinical characteristics, opioid prescription patterns, and payer costs for subjects who underwent either BKP or VP to treat VCF were evaluated beginning 6 months prior to surgery through 7-month follow-up that included a 30-day, postoperative medication washout. Patient demographics, changes in opioid utilization, and payer costs were analyzed.
A total of 8,845 patients met eligibility criteria (75.3% BKP and 24.7% VP) with a mean of age 77 and 74% female. Among the 75% of patients who used opioids, 48.7% of patients discontinued opioid medication and 8.4% reduced prescription fills versus preoperative baseline. Patients who reduced or discontinued prescriptions exhibited a decrease in all-cause payer costs relative to pre-intervention levels, which was a significantly greater change relative to patients with no change, increase, or new start of opioids.
Interventional treatment for VCF was associated with decreased or discontinued opioid prescription fills and reduced payer costs in follow-up in a significant proportion of the study population. Reduction of opioid-based harms may represent a previously unrecognized benefit of vertebral augmentation for VCF, especially in this elderly and medically fragile population.
本回顾性分析评估了在诊断为椎体压缩性骨折后接受球囊扩张椎体后凸成形术（N=6656）或经皮椎体成形术（N=2189）治疗的患者中，处方填充的实际趋势。在有阿片类药物使用证据的患者中，近一半的患者与术前水平相比停止或减少了处方填充。
椎体压缩性骨折（VCF）与老年患者的衰弱性疼痛、脊柱错位、死亡率增加和医疗资源利用增加有关。本研究评估了球囊扩张椎体后凸成形术（BKP）或经皮椎体成形术（VP）对 VCF 患者术后阿片类药物处方填充和支付者成本的影响。
这是一项对大型全国代表性保险索赔数据库的回顾性分析。评估了接受 BKP 或 VP 治疗 VCF 的患者的临床特征、阿片类药物处方模式和支付者成本，从手术前 6 个月开始，到 7 个月的随访结束，包括 30 天的术后药物洗脱期。分析了患者人口统计学、阿片类药物使用变化和支付者成本。
共有 8845 名患者符合入选标准（75.3%为 BKP，24.7%为 VP），平均年龄为 77 岁，74%为女性。在使用阿片类药物的 75%的患者中，48.7%的患者停止使用阿片类药物，8.4%的患者减少了处方用量，与术前基线相比。与未改变、增加或新开始使用阿片类药物的患者相比，减少或停止处方的患者在全因支付者成本方面表现出下降，这是一个显著更大的变化。
在研究人群的很大一部分中，VCF 的介入治疗与随访中减少或停止阿片类药物处方和降低支付者成本相关。减少阿片类药物相关危害可能代表了椎体增强治疗 VCF 的一个以前未被认识到的益处，尤其是在这个老年和医疗脆弱的人群中。
