title: Health care resource use and costs in opioid-treated patients with and without constipation in Brazil.
abstract: OBJECTIVE
  To estimate the prevalence of constipation concomitant to opioid treatment and related resource use and costs from the private payer perspective.
  
  
  METHODS
  In this retrospective database analysis, patients receiving opioid therapy were identified from a longitudinal insurance claims database. An algorithm was used to identify patients receiving opioid therapy with coincident constipation-related claims according to ICD-10 codes, targeted procedures, and opioid use criteria. Resource use and costs were determined for these individuals and compared with patients receiving opioid therapy without constipation, without opioid therapy with constipation, and without both conditions. Results were compared using analysis of variance with a significance level of 0.05.
  
  
  RESULTS
  A total of 23,313 patients were classified as opioid-treated patients (2.2%) and 6678 of them had events related to constipation (29.0%). Compared with opioid-treated patients without constipation, incremental mean total costs per month per patient were 261.18 BRL (P < 0.001). The average cost per month for opioid-related constipation patients was 787.84 BRL, significantly higher than other patients (P < 0.001 for all comparisons). Among cancer patients, 24.4% was receiving opioids and 27.0% of those had constipation-related claims. As expected, the opioid therapy prevalence was significantly higher when compared to all patients (2.2% vs. 24.4%, P < 0.001). Cancer patients had, in average, higher costs than did noncancer patients in all four subgroups.
  
  
  CONCLUSIONS
  Patients with constipation coincident with opioid treatment exhibited a significantly higher economic burden than did patients without the condition. These results indicate that reducing opioid-induced constipation could lead to potential cost savings for the health care system.
authors.affiliation: ANOVA - Knowledge Translation Consulting Group, Rio de Janeiro, Brazil. mairatakemoto@anova.org.br
authors.forename: Maira L S
authors.initials: ML
authors.lastname: Takemoto
authors.forename: R A
authors.initials: RA
authors.lastname: Fernandes
authors.forename: G R
authors.initials: GR
authors.lastname: Almeida
authors.forename: R D C
authors.initials: RD
authors.lastname: Monteiro
authors.forename: M
authors.initials: M
authors.lastname: Colombini-Neto
authors.forename: A
authors.initials: A
authors.lastname: Bertola-Neto
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000191:economics*; D000704:Analysis of Variance; D001938:Brazil / Q000453:epidemiology; D003248:Constipation / Q000139:chemically induced / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D003365:Costs and Cost Analysis; D019992:Databases as Topic; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D015995:Prevalence; D017149:Private Sector / Q000191:economics; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid