title: Daily average consumption of 2 long-acting opioids: an interrupted time series analysis.
abstract: BACKGROUND
  Oxycodone controlled release (CR) and oxymorphone extended release (ER) are frequently prescribed long-acting opioids, which are approved for twice-daily dosing. The US Food and Drug Administration approved a reformulated crush-resistant version of oxycodone CR in April 2010.
  
  
  OBJECTIVE
  To compare the daily average consumption (DACON) for oxycodone CR and for oxymorphone ER before and after the introduction of the reformulated, crush-resistant version of oxycodone CR.
  
  
  METHODS
  This was a retrospective claims database analysis using pharmacy claims from the MarketScan database for the period from January 2010 through March 2011. The interrupted time series analysis was used to evaluate the impact of the introduction of reformulated oxycodone CR on the DACON of the 2 drugs-oxycodone CR and oxymorphone ER. The source of the databases included private-sector health data from more than 150 medium and large employers. All prescription claims containing oxycodone CR and oxymorphone ER dispensed to members from January 1, 2010, to March 31, 2011, were included in the analysis. Prescription claims containing duplicate National Drug Codes, missing member identification, invalid quantities or inaccurate days supply of either drug, and DACON values of <1 and >500 were removed.
  
  
  RESULTS
  The database yielded 483,063 prescription claims for oxycodone CR and oxymorphone ER from January 1, 2010, to March 31, 2011. The final sample consisted of 411,404 oxycodone CR prescriptions (traditional and reformulated) dispensed to 85,150 members and 62,656 oxymorphone ER prescriptions dispensed to 11,931 members. Before the introduction of reformulated oxycodone CR, DACON values for the highest strength available for each of the 2 drugs were 0.51 tablets higher for oxycodone CR than for oxymorphone ER, with mean DACON values of 3.5 for oxycodone CR and 3.0 for oxymorphone ER (P <.001). The differences of mean DACON between the 2 drugs for all lower strengths were 0.46 tablets, with mean DACON values of 2.7 for oxycodone CR and 2.3 for oxymorphone ER (P <.001). After the introduction of the new formulation, the difference in mean DACON between the 2 drugs was slightly lower: 0.45 tablets for the highest-strength and 0.40 tablets for the lower-strength pairs. Regression analyses showed that the immediate and overall impact of the reformulation of oxycodone CR on the DACON of oxycodone CR was minimal, whereas no changes were seen in the DACON of oxymorphone ER. The estimated DACON for oxycodone CR decreased by 0.1 tablets, or 3.7% (P <.001), 6 months after the new formulation was introduced.
  
  
  CONCLUSIONS
  The mean DACON was 0.4 tablets per day higher for oxycodone CR compared with oxymorphone ER for all dosage strengths for the entire study period. After the introduction of the reformulated oxycodone CR, the DACON for this drug was slightly mitigated; however, there was a minimal impact on the mean differences between oxycodone CR and oxymorphone ER.
authors.affiliation: Associate Director of Health Outcomes and Pharmacoeconomics, Endo Pharmaceuticals, Chadds Ford, PA.
authors.forename: R Amy
authors.initials: RA
authors.lastname: Puenpatom
authors.affiliation: Professor, Division of Pharmacy Practice and Administration, College of Pharmacy, Ohio State University, Columbus.
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Szeinbach
authors.affiliation: Director, Health Outcomes and Pharmacoeconomics at Endo Pharmaceuticals, Chadds Ford, PA.
authors.forename: Larry
authors.initials: L
authors.lastname: Ma
authors.affiliation: Vice President, Health Outcomes and Pharmacoeconomics at Endo Pharmaceuticals, Chadds Ford, PA.
authors.forename: Rami H
authors.initials: RH
authors.lastname: Ben-Joseph
authors.affiliation: Senior Director, Health Outcomes and Pharmacoeconomics at Endo Pharmaceuticals, Chadds Ford, PA.
authors.forename: Kent H
authors.initials: KH
authors.lastname: Summers