Increased Burden of Healthcare Utilization and Cost Associated with Opioid-Related Constipation Among Patients with Noncancer Pain.
BACKGROUND
Opioids are widely accepted as treatment for moderate to severe pain, and opioid-induced constipation is one of the most common side effects of opioids. This side effect negatively affects pain management and patients' quality of life, which could result in increased healthcare utilization and costs.


OBJECTIVE
To assess healthcare utilization and costs (all-cause, constipation-related, and pain-related) for individuals with and without opioid-induced constipation during the 12 months after initiation of opioid therapy for noncancer pain.


METHODS
This retrospective cohort study was conducted using administrative claims data from HealthCore Integrated Research Environment between January 1, 2006, and June 30, 2014. The analysis was limited to patients aged ≥18 years who filled a prescription for continuous opioid treatment (≥28 days) for noncancer pain. Propensity scores were used to match opioid users with constipation (cohort 1) and opioid users without constipation (cohort 2), using a 1:1 ratio. Generalized linear models were used to estimate all-cause, constipation-related, and pain-related healthcare utilization and costs during the 12 months after the initiation of opioid therapy.


RESULTS
After matching and balancing for all prespecified variables, 17,384 patients were retained in each cohort (mean age, 56 years; 63% female). Opioid users with constipation were twice as likely as those without constipation to have ≥1 inpatient hospitalizations (odds ratio, 2.28; 95% confidence interval [CI], 2.17-2.39) during the 12 months. The total mean adjusted overall costs per patient during the study period were $12,413 higher for patients with constipation versus those without it (95% CI, $11,726-$13,116). The total mean adjusted overall pain-related costs per patient were $6778 (95% CI, $6293-$7279) higher for the patients with constipation than those without. Among patients using opioids for noncancer pain, the annual mean constipation-related costs per patient totaled $4646 (total average plan-paid costs, $4424; total patient-paid costs, $222).


CONCLUSIONS
Patients using opioids with newly diagnosed constipation had significantly greater healthcare utilization and costs than patients without constipation; these costs accounted for approximately 16% of the total healthcare costs per patient during the 12-month study period. Recognition and effective treatment of opioid-induced constipation may decrease healthcare utilization for patients with chronic noncancer pain and may reduce the economic burden of pain therapy.
Director, Health Outcomes and Pharmacoeconomics, AstraZeneca Pharmaceuticals LP, Gaithersburg, MD.
Ancilla W
AW
Fernandes
Associate Director, HealthCore, Inc.
David M
DM
Kern
Medical Lead, US Medical Affairs, AstraZeneca Pharmaceuticals LP.
Catherine
C
Datto
Senior Researcher, HealthCore, Inc.
Yen-Wen
YW
Chen
Senior Field Medical Director, US Medical Affairs, AstraZeneca Pharmaceuticals LP.
Charles
C
McLeskey
Director, HealthCore, Inc, all at Wilmington, DE.
Ozgur
O
Tunceli
healthcare costs; healthcare utilization; noncancer pain; opioid-induced constipation; opioids; pain management