title: Economic burden of opioid-induced constipation among long-term opioid users with noncancer pain.
abstract: BACKGROUND
  Opioid-induced constipation (OIC) can be a debilitating side effect of opioid therapy and may result in increased medical costs. The published data on the economic burden of OIC among long-term opioid users are limited.
  
  
  OBJECTIVE
  To assess the economic burden of OIC in patients with noncancer pain in a managed care population in the United States.
  
  
  METHODS
  This retrospective study used 2007-2011 data from the Truven Health MarketScan Commercial and Medicare databases. The study included adults with ≥12 months of insurance enrollment before and after starting long-term (≥90 days) use of opioids. Patients were excluded if they had cancer or a diagnosis of drug abuse or drug dependence during the study period, or if they had constipation or bowel obstruction within 90 days before starting opioid therapy during the study period. OIC was identified by International Classification of Diseases, Ninth Edition codes for constipation (564.0) or bowel obstruction (560.x) within 12 months of the initiation of an opioid. Patients with OIC were identified in the nonelderly, elderly (age ≥65 years), and long-term care populations. Differences in costs and healthcare resource utilization were calculated using propensity scoring.
  
  
  RESULTS
  A total of 13,808 nonelderly (age, 48.6 ± 10.4 years; female, 50%) and 2958 elderly patients (age, 78.7 ± 8.1 years; female, 70%) met the study inclusion criteria. Of 401 nonelderly and 194 elderly patients with OIC, 85 patients initiated opioid therapy in a long-term care facility (age, 80.7 ± 11.6 years; female, 77%). After matching by key covariates, patients with OIC had significantly more hospital admissions than patients without OIC (nonelderly, 33% vs 22%, respectively; P <.001; elderly, 51% vs 31%, respectively; P <.001) and longer inpatient stays (nonelderly, 3.0 ± 8.4 days vs 1.0 ± 3.0 days, respectively; P <.001; elderly, 5.2 ± 12.2 days vs 2.1 ± 4.0 days, respectively; P <.001). The group with OIC had significantly higher total healthcare costs than the group without OIC in all 3 study cohorts (nonelderly, $23,631 ± $67,209 vs $12,652 ± $19,717, respectively; elderly, $16,923 ± $38,191 vs $11,117 ± $19,525, respectively; long-term care, $16,000 ± $22,897 vs $14,437 ± $25,690, respectively; all P <.05).
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first study to analyze the economic impact of long-term use of opioids among patients with OIC, using real-world data. The findings underscore the significant economic burden associated with long-term opioid use for noncancer pain in a managed care population. Effective therapies for OIC may reduce the associated economic burden and improve quality of life for long-term opioid users.
authors.affiliation: Associate Scientist, Pharmerit International, Bethesda, MD.
authors.forename: Yin
authors.initials: Y
authors.lastname: Wan
authors.affiliation: Senior Clinical Outcomes Scientist, Pharmerit International, Bethesda, MD.
authors.forename: Shelby
authors.initials: S
authors.lastname: Corman
authors.affiliation: Senior Director, Pharmerit International, Bethesda, MD.
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
authors.affiliation: Outcomes Research Analyst, Pharmerit International, Bethesda, MD.
authors.forename: Sizhu
authors.initials: S
authors.lastname: Liu
authors.affiliation: Fellow in Global Outcomes Research, Takeda Pharmaceuticals International, Inc, Deerfield, and Consultant, Immensity Consulting, Inc, Chicago, IL.
authors.forename: Haridarshan
authors.initials: H
authors.lastname: Patel
authors.affiliation: Associate Director, Outcomes Research, Takeda Pharmaceuticals International, Inc, Deerfield, IL.
authors.forename: Reema
authors.initials: R
authors.lastname: Mody
keywords: constipation; economic burden; elderly; healthcare resource utilization; long-term care; long-term opioid use; opioid-induced constipation; pain management