Pfizer Ltd, Tadworth, UK.
Pfizer Australia Pty Ltd, Sydney, New South Wales, Australia.
BMJ Open. 2023 Jul 12;13(7):e067545. doi: 10.1136/bmjopen-2022-067545.
Despite the prevalence of osteoarthritis (OA) in England, few studies have examined the health economic impact of chronic pain associated with OA. The aim of this study was to compare outcomes in patients with moderate-to-severe chronic pain associated with OA and matched controls without known OA.
Retrospective, longitudinal, observational cohort study.
Electronic records extracted from the Clinical Practice Research Datalink GOLD primary care database linked to Hospital Episode Statistics (HES) data set.
Patients (cases; n=5931) ≥18 years and with existing diagnosis of OA and moderate-to-severe pain associated with their OA, and controls matched on age, sex, comorbidity burden, general practitioner (GP) practice and availability of HES data.
None.
Total healthcare resource use (HCRU) and direct healthcare costs during 0-6, 0-12, 0-24 and 0-36 months of follow-up. Secondary outcomes measures included pharmacological management and time to total joint replacement.
Patients with moderate-to-severe chronic pain associated with OA used significantly more healthcare services versus matched controls, reflected by higher HCRU and significantly higher direct costs. During the first 12 months' follow-up, cases had significantly more GP consultations, outpatient attendances, emergency department visits and inpatient stays than matched controls (all p<0.0001). Total mean costs incurred by cases during 0-12 months' follow-up were five times higher in cases versus controls (mean (SD): £4199 (£3966) vs £781 (£2073), respectively). Extensive cycling through pharmacological therapies was observed; among cases, 2040 (34.4%), 1340 (22.6%), 841 (14.2%), 459 (7.7%) and 706 (11.9%) received 1-5, 6-10, 11-15, 16-20 and >20 lines of therapy, respectively.
This wide-ranging, longitudinal, observational study of real-world primary and secondary care data demonstrates the impact of moderate-to-severe chronic pain associated with OA in patients compared with matched controls. Further studies are required to fully quantify the health economic burden of moderate-to-severe pain associated with OA.
尽管骨关节炎（OA）在英国普遍存在，但很少有研究检查与 OA 相关的慢性疼痛对健康经济的影响。本研究旨在比较伴有中重度慢性疼痛的 OA 患者与无已知 OA 的匹配对照者的结局。
回顾性、纵向、观察性队列研究。
从临床实践研究数据链接到医院事件统计（HES）数据集的 Gold 初级保健数据库中提取电子记录。
≥18 岁且存在 OA 现有诊断和与 OA 相关的中重度疼痛的患者（病例；n=5931），以及按年龄、性别、合并症负担、全科医生（GP）实践和 HES 数据可用性匹配的对照者。
无。
0-6、0-12、0-24 和 0-36 个月随访期间的总医疗资源使用（HCRU）和直接医疗费用。次要结局测量包括药物管理和全关节置换的时间。
与匹配对照者相比，伴有中重度慢性疼痛的 OA 患者使用了明显更多的医疗服务，表现为更高的 HCRU 和显著更高的直接成本。在最初 12 个月的随访期间，病例的 GP 咨询、门诊就诊、急诊就诊和住院治疗次数明显多于匹配对照者（均<0.0001）。病例在 0-12 个月随访期间的总平均费用是对照者的五倍（平均（SD）：£4199（£3966）vs £781（£2073））。观察到药物治疗方案的广泛循环；在病例中，分别有 2040（34.4%）、1340（22.6%）、841（14.2%）、459（7.7%）和 706（11.9%）接受了 1-5、6-10、11-15、16-20 和>20 条治疗线。
这项对真实世界初级和二级保健数据的广泛、纵向、观察性研究表明，与匹配对照者相比，OA 相关的中重度慢性疼痛对患者具有影响。需要进一步研究来充分量化 OA 相关的中重度疼痛的健康经济负担。
