title: Economic impact of potential drug-drug interactions in opioid analgesics.
abstract: OBJECTIVE
  Patients managing chronic non-cancer pain with cytochrome P450 (CYP450)-metabolized opioid analgesics who concurrently take another CYP450-metabolized medication experience a drug-drug exposure (DDE), which puts them at risk for a pharmacokinetic drug-drug interaction (PK DDI). This study examined the economic impact of incident DDEs with the potential to cause PK DDIs compared to similar patients without such exposure.
  
  
  METHODS
  This retrospective analysis used paid claims from a large, commercially insured population during January 1, 2004 through December 31, 2008.
  
  
  METHODS
  Propensity matching was used to control for baseline differences in comparisons between 85,043 exposed and 85,043 non-exposed patients.
  
  
  RESULTS
  Comparisons yielded mean total costs 6 months after the DDEs that were significantly higher in subjects with DDE versus matched subjects without DDE [$8165 (SD $11,357) vs. $7498 (SD $11,668), respectively, p<0.01] resulting in a difference of $667. This was driven by medical costs [$5520 (SD $10,505) vs. $5222 (SD $10,689), respectively, p<0.01] a $298 difference, and total prescription costs [$2646 (SD $3262) vs. $2276 (SD $3907), respectively, p<0.01] a $369 difference.
  
  
  CONCLUSIONS
  The study design demonstrates associations only and cannot establish causal relationships. Further, relevant DDEs were not included if concurrent consumption occurred outside the index period and when CYP450 substances were consumed that are not reflected in pharmacy claims (herbals, over-the-counter medications).
  
  
  CONCLUSIONS
  Since concurrent exposure to DDEs with the potential to cause PK DDIs may be relatively common, policy decisions-makers should consider the use of long-acting opioids that are not metabolized through the CYP450 pathway.
authors.affiliation: Department of Health Outcomes and Pharmacoeconomics (HOPE), Endo Pharmaceuticals, 100 Endo Boulevard, Chadds Ford, PA 19317, USA. summers.kent@endo.com
authors.forename: Kent H
authors.initials: KH
authors.lastname: Summers
authors.forename: R Amy
authors.initials: RA
authors.lastname: Puenpatom
authors.forename: Niveda
authors.initials: N
authors.lastname: Rajan
authors.forename: Rami
authors.initials: R
authors.lastname: Ben-Joseph
authors.forename: Robert
authors.initials: R
authors.lastname: Ohsfeldt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000493:pharmacokinetics* / Q000627:therapeutic use; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism*; D004347:Drug Interactions; D017850:Economics, Pharmaceutical / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D003577:Cytochrome P-450 Enzyme System