Use and costs of prescription medications and alternative treatments in patients with osteoarthritis and chronic low back pain in community-based settings.
OBJECTIVE
To evaluate the use and direct medical costs of pharmacologic and alternative treatments for patients with osteoarthritis (OA) and chronic low back pain (CLBP).


METHODS
The LifeLink™ Health Plan Claims Database was used to identify patients ≥18 years old, diagnosed with OA (N = 112,951) or CLBP (N = 101,294). Of these patients, 64,085 with OA and 47,386 with CLBP received pain-related treatments during CY2008 and were selected for inclusion. For patients in both cohorts, pharmacologic and alternative treatments, and direct medical costs were examined during CY2008.


RESULTS
Opioids were the most frequently prescribed medication (>70%) in both groups, followed by nonselective nonsteroidal anti-inflammatory drugs (>50%). Over 30% received antidepressants, >20% received benzodiazepines, and 15% in each group received sedative hypnotics. Use of alternative treatments was as follows: chiropractor, OA 11%, CLBP 34%; physical therapy, 20% in both groups; transcutaneous electrical nerve stimulations (TENS), OA 14%, CLBP 22%; acupuncture, hydrotherapy, massage therapy, and biofeedback, <3% in both groups. Mean (SD) total healthcare costs among these patients were, OA: $15,638 ($22,595); CLBP: $11,829 ($20,035). Pharmacologic therapies accounted for approximately 20% of these costs, whereas alternative treatments accounted for only 3% to 4% of the total costs.


CONCLUSIONS
Patients with OA and CLBP used a variety of pain-related and adjunctive medications. Although, alternative treatments are widely recommended, we found limited use of several of these in clinical practice, potentially due to the source of our data (commercial claims). Further research is needed to ascertain the extent to which such therapies contribute to the total costs of OA and CLBP management.
Avalon Health Solutions, Inc., Philadelphia, Pennsylvania, USA. mgore@avalonhealthsolutions.com
Mugdha
M
Gore
Kei-Sing
KS
Tai
Alesia
A
Sadosky
Douglas
D
Leslie
Brett R
BR
Stacey
D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000191:economics* / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics / Q000627:therapeutic use; D002908:Chronic Disease; D000529:Complementary Therapies / Q000191:economics* / Q000379:methods; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006801:Humans; D017116:Low Back Pain / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D010003:Osteoarthritis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D055553:Prescription Drugs / Q000191:economics / Q000627:therapeutic use; D012111:Residence Characteristics; D012189:Retrospective Studies; D055815:Young Adult
D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D055553:Prescription Drugs