title: Medical resource use and costs among pain patients with potential opioid-tolerability issues.
abstract: OBJECTIVE
  To estimate excess medical resource use and costs associated with prescription opioid (RxO) tolerability issues.
  
  
  METHODS
  This was an observational, retrospective analysis of deidentified administrative claims data.
  
  
  METHODS
  The study included commercially insured patients treated in different healthcare settings captured in the Truven MarketScan claims database.
  
  
  METHODS
  Patients aged 18-64 years initiating treatment with an RxO (index) and continuously treated with pain relievers over a 6-month period were selected. "Switchers" were patients who discontinued their index RxO and switched to non-RxO pain relievers < 30 days post-index, and whose last pain reliever in the 6-month follow-up period was not an RxO. Such switching was considered a proxy for RxO-tolerability issues. "Continuous RxO users" were patients who remained on the index RxO for the follow-up period. Switchers and continuous RxO users were matched 1:1 on propensity score, baseline medical costs, index RxO days supply, and short-/long-acting index RxO.
  
  
  METHODS
  Six-month follow-up medical resource use and costs were compared between matched switchers and continuous RxO users.
  
  
  RESULTS
  A total of 10,704 pairs of switchers and continuous RxO users were matched. In the 6-month follow-up period, switchers had more outpatient (7.5 vs 6.8; p < 0.001) and inpatient (0.05 vs 0.04; p = 0.002) visits and longer inpatient stays (0.26 days vs 0.19; p = 0.006) compared to continuous RxO users. Switchers also had higher total medical costs ($4,522 vs $3,657; p < 0.001).
  
  
  CONCLUSIONS
  Switchers incur greater medical resource use and costs than similar patients continuously treated with their index RxO.
authors.affiliation: Manager, Analysis Group, Inc., Boston, Massachusetts.
authors.forename: Noam Y
authors.initials: NY
authors.lastname: Kirson
authors.affiliation: Associate, Analysis Group, Inc., Boston, Massachusetts.
authors.forename: Amie
authors.initials: A
authors.lastname: Shei
authors.affiliation: Principal, Analysis Group, Inc., Boston, Massachusetts.
authors.forename: Howard G
authors.initials: HG
authors.lastname: Birnbaum
authors.affiliation: Head of Health Outcomes and PharmacoEconomics, Purdue Pharma L.P., Boston, Massachusetts.
authors.forename: Rami
authors.initials: R
authors.lastname: Ben-Joseph
authors.affiliation: Anesthesiologist, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Edward
authors.initials: E
authors.lastname: Michna
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004361:Drug Tolerance; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid