title: Impact of constipation on opioid use patterns, health care resource utilization, and costs in cancer patients on opioid therapy.
abstract: Patterns of opioid use, resource utilization, and costs in cancer patients with and without constipation were compared using retrospective insurance claims data. Inclusion criteria were > =30 days of opioid use and continuous plan coverage for > or =6 months before and > or =12 months following first opioid claim (index date). Constipation was defined as > or =1 ICD-9-CM diagnosis codes in the range of 564.0x during the 12 months postindex date. Of the 8836 opioid initiators with cancer initially considered, approximately 9.3% (n = 821) had a diagnosis of constipation during follow-up. Opioid use patterns were compared between patients with constipation and matched controls. Two-part semilogarithmic regression models assessed the impact of constipation on resource utilization and associated costs. Compared with controls without constipation, patients with constipation had higher rates of concurrent use of > or =2 opioids (P < .0001), opioid discontinuation (P = .0002), opioid switching (P < .0001), nausea with vomiting (P < .0001), and respiratory depression (P = .0003). Compared with controls, more patients with constipation received inpatient (P < .0001), hospice (P = .0086), home health (P < .0001), laboratory (P = .0015), other outpatient (P < .0001), emergency (P < .0001), office visit (P < .0001), and nursing home care (P = .0266). Compared with controls, patients with constipation had substantially higher total costs (P < .0001). This study suggests that in opioid-treated cancer patients, constipation significantly impacts opioid-use patterns, resource utilization, and costs. Alleviation of constipation may optimize opioid therapy and reduce costs.
authors: RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC 27709, USA. scandrilli@rti.org
authors: Sean D
authors: SD
authors: Candrilli
authors: Keith L
authors: KL
authors: Davis
authors: Shrividya
authors: S
authors: Iyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D003248:Constipation / Q000139:chemically induced*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D012044:Regression Analysis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid