Disease Burden and Costs in Moderate-to-Severe Chronic Osteoarthritis Pain Refractory to Standard of Care: Ancillary Analysis of the OPIOIDS Real-World Study

Abstract

Introduction To determine the disease burden and costs in moderate-to-severe chronic osteoarthritis (OA) pain refractory to standard-of-care treatment in the Spanish National Health System (NHS). Methods Ancillary analysis of the OPIOIDS real-world, non-interventional, retrospective, 4-year longitudinal study including patients aged at least 18 years with moderate-to-severe chronic OA pain refractory to standard-of-care with sequential NSAIDs plus opioids. Burden assessment included measurement of analgesia, cognitive functioning, basic activities of daily living, severity and frequency of comorbidities, and all-cause mortality. Costs accounted for healthcare resource utilization and related costs (year 2018). Results Records of 13,317 patients were analyzed; 68.9 (14.7) years old, 71.3% (70.5–72.1%) women, 58.1% refractory to NSAID plus weak opioid and 41.9% to NSAID plus strong opioid, accounting for 10.7% (10.5–10.8%) of patients with chronic OA pain. Mean number of comorbidities was 2.9 (1.8) and its severity was 1.8 (1.7). Pain decreased by 0.9 points (12.2%) and cognitive declined by 2.3 points (9.1%, with 4.3% more patients with cognitive deficit) and dependency worsened by 0.4 points (0.5%, with 2.3% more patients with severe-to-total dependence) over a mean treatment period of 188.6 (185.4–191.8) days on NSAIDs followed by 400.6 (393.7–407.5) days on opioids. The adjusted mortality rate was higher in patients with OA taking NSAID plus strong opioids; hazard ratio 1.44 (1.26–1.65; p < 0.001). The 4-year healthcare cost was €7350/patient (€7193–7507 or €1838/year) and was higher in those taking strong versus weak opioids; €9886 (€9608–10,164, €2472/year) vs. €5519 (€5349–5689, €1380/year), p < 0.001. Analgesia cost (16.0% of total cost, 70.2% opioids) was higher with strong versus weak opioids, 19.6% vs. 11.3%, p < 0.001. Conclusions In routine clinical practice in Spain, patients with moderate-to-severe chronic OA pain refractory to standard analgesic treatment with NSAIDs plus opioids reported modest reductions in pain, while presenting a considerable burden of comorbidities, cognitive impairment, and dependency. Healthcare costs significantly increased for the NHS particularly with NSAIDs plus strong opioids. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-020-00271-y.

An Observational Retrospective Matched Cohort Study of Healthcare Resource Utilisation and Costs in UK Patients with Moderate to Severe Osteoarthritis Pain

“…This was significantly higher than for patients in the control cohorts and consistent with our findings for higher HCRU and analgesic use. Many other studies have demonstrated the high cost of OA to healthcare systems, particularly for the management of patients with moderate to severe or severe pain [ 13 , 15 – 17 , 19 , 22 , 24 , 27 , 39 , 48 ]. Our multivariable analysis showed that older age at index or the presence of gout, osteoporosis, type 2 diabetes, or coronary artery disease was associated with an increased cost of healthcare in all cohorts, but with generally higher proportional contributions in control cohorts than the OA pain cohorts.…”

Future projections of opioid use and cost in patients with chronic osteoarthritis pain in Spain

“…43,44 Particularly worrisome is the excess mortality associated with opioid use as described in the scientific literature, [45][46][47][48] mainly with strong opioids, which has also been observed in Spanish OA patients receiving strong opioids in the OPIOIDS study. 31,33 (A) (B) We used a real-world approach to project the future opioid burden for OA, based on recent opioid dispensing trends by the AEMPS, anticipated growth in the OA population and the opioid utilization rates observed in the real-world OPIOIDS study. 30,31,33 By assuming no change in opioid prescribing practices, our study provides an important baseline for health decision makers and clinicians in Spain, in order to evaluate the potential impacts of future strategies that aim to address inappropriate opioid prescribing.…”

“…31,33 (A) (B) We used a real-world approach to project the future opioid burden for OA, based on recent opioid dispensing trends by the AEMPS, anticipated growth in the OA population and the opioid utilization rates observed in the real-world OPIOIDS study. 30,31,33 By assuming no change in opioid prescribing practices, our study provides an important baseline for health decision makers and clinicians in Spain, in order to evaluate the potential impacts of future strategies that aim to address inappropriate opioid prescribing. We also performed a sensitivity analysis and an analysis in subgroups of patients with OA pain (NSAIDrefractory and those taking strong opioids only), which showed that the growing trend in future opioid burden would remain unless international recommendations on opioid use are implemented, or newer therapeutic strategies based on drugs with a novel mechanism of action replace current drug-based analgesia of chronic OA pain.…”

“…43,44 Particularly worrisome is the excess mortality associated with opioid use as described in the scientific literature, [45][46][47][48] mainly with strong opioids, which has also been observed in Spanish OA patients receiving strong opioids in the OPIOIDS study. 31,33 (A) (B) Data expressed in number of DHD (DDD/1000 patients per day). Upper and lower bound are 95% probabilistic confidence interval.…”

“…The sensitivity analysis also included subgroup analyses in OA patients. These included patients with chronic NSAID-refractory OA pain, 33 and both patients with chronic OA pain and those with pain which is refractory to NSAIDs and taking strong opioids only. In accordance with the weighted opioid cost of a DDD in 2010 (€1.48 for chronic OA pain patients and €1.62 for refractory), the corresponding cost was €116.9m for chronic OA pain patients and €45.0m for patients with chronic NSAID-refractory OA pain (Tables 2 and 3).…”