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Healthcare Costs Associated With Chronic Opioid Use and Fibromayalgia Syndrome.

ABSTRACT: BACKGROUND:Fibromyalgia (FM) is an idiopathic, functional syndrome characterized by chronic, widespread pain and diffuse tenderness. This disorder affects more than 6 million patients in the United States and is associated with significant clinical and economic burdens. OBJECTIVES:The objectives of this study were to: 1) estimate the costs associated with a FM diagnosis; and 2) estimate the impact of chronic opioid use on the costs of FM patients. RESEARCH DESIGN:Case-control study. METHODS:Subjects were identified in a large nationally representative database of commercially insured patients. Propensity score-matched analyses included 445,912 FM-control pairs in the first analysis, while the second analysis included 48,333 chronic opioid users with the FM-control pairs. Primary outcomes of interest were the medical and prescription costs compared between matched pairs, based on propensity for being a case as evidenced by coefficients obtained from a first-stage logistic regression. Patient characteristics considered include: state of residence, diagnosing provider type, comorbid conditions, and concurrent medication use. RESULTS:When controlling for propensity to receive a FM diagnosis, the actual diagnosis has a small effect on medical (-$83.54 [95% CI, -152.55 to -16.53]) and prescription ($120.31 [95% CI, 109.98-130.62]) costs. However, the effect of chronic opioid use in FM patients on medical ($9094.05 [95% CI, 8924.79-9263.31]) and prescription ($3391.81 [95% CI, 3368.84-3414.79]) costs is much more substantial. CONCLUSIONS:While the differences seen in FM patients and controls are marginal, those attributed to chronic opioid use in these patients are significantly higher. Chronic opioid therapy to treat FM is a practice based not on evidence available to practitioners, but on other variables.

SUBMITTER: Painter JT

PROVIDER: S-EPMC5444874 | biostudies-literature | 2014 Nov-Dec

REPOSITORIES: biostudies-literature

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Healthcare Costs Associated With Chronic Opioid Use and Fibromayalgia Syndrome.

Painter Jacob T JT Crofford Leslie J LJ Butler J S JS Talbert Jeffery J

The American journal of pharmacy benefits 20141101 6

<h4>Background</h4>Fibromyalgia (FM) is an idiopathic, functional syndrome characterized by chronic, widespread pain and diffuse tenderness. This disorder affects more than 6 million patients in the United States and is associated with significant clinical and economic burdens.<h4>Objectives</h4>The objectives of this study were to: 1) estimate the costs associated with a FM diagnosis; and 2) estimate the impact of chronic opioid use on the costs of FM patients.<h4>Research design</h4>Case-contr ...[more]

PMID: 28553437

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Project description:STUDY DESIGN:A descriptive analysis of secondary data. OBJECTIVE:The aim of this study was to estimate health care costs and opioid use for those with high-impact chronic spinal (back and neck) pain. SUMMARY OF BACKGROUND DATA:The US National Pain Strategy introduced a focus on high-impact chronic pain-that is, chronic pain associated with work, social, and self-care restrictions. Chronic neck and low-back pain are common, costly, and associated with long-term opioid use. Although chronic pain is not homogenous, most estimates of its costs are averages that ignore severity (impact). METHODS:We used 2003 to 2015 Medical Expenditures Panel Survey (MEPS) data to identify individuals with chronic spinal pain, their health care expenditures, and use of opioids. We developed prediction models to identify those with high- versus moderate- and low-impact chronic spinal pain based on the variables available in MEPS. RESULTS:We found that overall and spine-related health care costs, and the use and dosage of opioids increased significantly with chronic pain impact levels. Overall and spine-related annual per person health care costs for those with high-impact chronic pain ($14,661 SE: $814; and $5979 SE: $471, respectively) were more than double that of those with low-impact, but still clinically significant, chronic pain ($6371 SE: $557; and $2300 SE: $328). Those with high-impact chronic spinal pain also use spine-related opioids at a rate almost four times that of those with low-impact pain (48.4% vs. 12.4%), and on average use over five times the morphine equivalent daily dose (MEDD) in mg (15.3 SE: 1.4 vs. 2.7 SE: 0.6). Opioid use and dosing increased significantly across years, but the increase in inflation-adjusted health care costs was not statistically significant. CONCLUSION:Although most studies of chronic spinal pain do not differentiate participants by the impact of their chronic pain, these estimates highlight the importance of identifying chronic pain levels and focusing on those with high-impact chronic pain. LEVEL OF EVIDENCE:3.

Project description:IntroductionTo compare all-cause and endometriosis-related healthcare resource utilization (HCRU) and healthcare costs by service categories (outpatient, inpatient, emergency room [ER], pharmacy) among patients with newly diagnosed endometriosis using opioids compared to patients with endometriosis not using opioids.MethodsA retrospective analysis of IBM® MarketScan® Commercial Claims data from 2009 to 2018 was performed for women aged 18-49 with newly diagnosed endometriosis (International Classification of Diseases (ICD)-9 code 617.xx; ICD-10 code N80.xx) over 24 months follow-up. Patients were stratified on the basis of opioid use within 12 months post first endometriosis diagnosis date. Patients with opioid use were 1:1 matched to patients without opioid use using propensity score matching.ResultsA total of 85,329 female patients with a new endometriosis diagnosis were identified and 48,470 patients (24,235 opioid and 24,235 non-opioid users) remained after inclusion-exclusion criteria and matching. Opioid patients had an estimated mean 30.33 outpatient visits, 29.59 pharmacy fills, 0.28 inpatient visits, 0.65 ER visits, and total length of stay (LOS) was 1.01 days. Non-opioid patients had an estimated mean 27.94 outpatient visits, 22.06 pharmacy fills, 0.23 inpatient visits, 0.42 ER visits, and total LOS was 0.82 days. On average, opioid patients had significantly greater all-cause HCRU compared to non-opioid patients (all p < 0.0001). Among endometriosis-related healthcare utilization, there were similar ER visits, but lower outpatient visits, inpatient visits, and total LOS and higher pharmacy fills among opioid and non-opioid patients. Estimated mean all-cause costs were higher among opioid ($26,755) vs. non-opioid ($19,302) users (p < 0.0001). A similar trend was observed for estimated mean endometriosis-related costs.ConclusionThis analysis observed significantly higher all-cause HCRU and costs for opioid users compared to non-opioid users among patients with newly diagnosed endometriosis. While observed endometriosis-related costs were significantly higher in opioid users compared to non-opioid users during a 24-month follow-up period, endometriosis-related HCRU varied by service categories for these two populations over this time period.

Project description:BackgroundOpioid use by patients with inflammatory bowel disease (IBD) has been associated with poorer health outcomes. This study describes socioeconomic characteristics; health utilization trends; and costs of patients with IBD and either no opioid prescriptions, or in 1 of 3 opioid duration categories based on Center for Disease Control guidelines: acute (0-30 days), moderate (31-90 days), or chronic (>90 days). We utilized the Cost of IBD Care Optum research database results for this study.MethodsThe Optum Research Database from years 2007 to 2016 including IBD patients with commercial or Medicare Advantage insurance in the United States was used. Additional inclusion criteria included continuous enrollment with medical and pharmacy benefit coverage for at least 24 months (12 months before and 12 months after the index date of IBD diagnosis). The association between costs and patient characteristics were assessed across a no opioid use group during this period and the 3 opioid duration groups.ResultsAmong 51,178 IBD patients, 33,229 (64.93%) were part of the no opioid use group, while 13,635 (26.64%) were in acute, 1698 (3.32%) were in moderate, and 2616 (5.11%) were in chronic use groups, as determined by pharmacy claims data. Patients in the chronic group were more likely to be white (75.38%) compared to all the other groups (no opioid use, acute, and moderate), have attained less education (only high school diploma), have had lower incomes, and have had Medicare instead of commercial insurance. Patients across all opioid prescription groups were more likely to have had diagnoses associated with pain in the prior year, with rates increasing by the length of opioid prescription (63.68%, 80.17%, and 86.11% for acute, moderate, and chronic groups). Compared to the no-use group, the acute group had more ambulatory (outpatient) visits, while the chronic group had fewer. Emergency department visits and inpatient hospitalizations were higher in all 3 opioid groups compared to the no opioid use group. Ambulatory, emergency department, inpatient, and total (medical + pharmacy) costs were higher in all 3 opioid groups, compared to the no opioid use group, even after adjusting for demographic and clinical patient characteristics.ConclusionsAmong patients with IBD, increasing opioid use was associated with higher healthcare resource utilization and, concomitantly, higher healthcare costs during this period.

Project description:To investigate multimorbidity transitions from general practice populations across healthcare interfaces and the associated healthcare costs.Clinical-linkage database study.Population (N=60 660) aged 40 years and over registered with 53 general practices in Stoke-on-Trent.Population with six specified multimorbidity pairs were identified based on hypertension, diabetes mellitus (DM), coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and chronic kidney disease (CKD).Chronic disease registers were linked to accident and emergency (A&E) and hospital admissions for a 3-year time period (2007-2009), and associated costs measured by Healthcare Resource Groups. Associations between multimorbid groups and direct healthcare costs were compared with their respective single disease groups using linear regression methods, adjusting for age, gender and deprivation.In the study population, there were 9735 patients with hypertension and diabetes (16%), 3574 with diabetes and CHD (6%), 2894 with diabetes and CKD (5%), 1855 with COPD and CHD (3%), 754 with CHF and COPD (1%) and 1425 with CHF and CKD (2%). Transition, defined as at least one episode in each of the 3-year time periods, was as follows: patients with hypertension and DM had the fewest transitions in the 3-year time period (37% A&E episode and 51% hospital admission), but those with CHF and CKD had the most transitions (67% A&E episode and 79% hospital admission). The average 3-year total costs per multimorbid patient for A&E episodes ranged from £69 to £166 and for hospital admissions ranged from between £2289 and £5344. The adjusted costs were significantly higher for all six multimorbid groups compared with their respective single disease groups.Specific common multimorbid pairs are associated with higher healthcare transitions and differential costs. Identification of multimorbidity type and linkage of information across interfaces provides opportunities for targeted intervention and delivery of integrated care.

Project description:OBJECTIVE:To determine the association of medical marijuana legalization with prescription opioid utilization. METHODS:A 10% sample of a nationally representative database of commercially insured population was used to gather information on opioid use, chronic opioid use, and high-risk opioid use for the years 2006-2014. Adults with pharmacy and medical benefits for the entire calendar year were included in the population for that year. Multilevel logistic regression analysis, controlling for patient, person-year, and state-level factors, were used to determine the impact of medical marijuana legalization on the three opioid use measures. Sub-group analysis among cancer-free adults and cancer-free adults with at least one chronic non-cancer pain condition in the particular year were conducted. Alternate regression models were used to test the robustness of our results including a fixed effects model, an alternate definition for start date for medical marijuana legalization, a person-level analysis, and a falsification test. RESULTS:The final sample included a total of 4,840,562 persons translating into 15,705,562 person years. Medical marijuana legalization was found to be associated with a lower odds of any opioid use: OR = 0.95 (0.94-0.96), chronic opioid use: OR = 0.93 (0.91-0.95), and high-risk opioid use: OR = 0.96 (0.94-0.98). The findings were similar in both the sub-group analyses and all the sensitivity analyses. The falsification tests showed no association between medical marijuana legalization and prescriptions for antihyperlipidemics (OR = 1.00; CI 0.99-1.01) or antihypertensives (OR = 1.00; CI 0.99-1.01). CONCLUSIONS:In states where marijuana is available through medical channels, a modestly lower rate of opioid and high-risk opioid prescribing was observed. Policy makers could consider medical marijuana legalization as a tool that may modestly reduce chronic and high-risk opioid use. However, further research assessing risk versus benefits of medical marijuana legalization and head to head comparisons of marijuana versus opioids for pain management is required.

Dataset Information

Healthcare Costs Associated With Chronic Opioid Use and Fibromayalgia Syndrome.

Publications

Healthcare Costs Associated With Chronic Opioid Use and Fibromayalgia Syndrome.

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