Health outcomes and costs in patients with osteoarthritis and chronic pain treated with opioids in Spain: the OPIOIDS real-world study

Abstract

Objective: The objective of this study was to analyze health outcomes, resource utilization, and costs in osteoarthritis patients with chronic nociceptive pain who began treatment with an opioid in real-world practice in Spain. Methods: We designed a non-interventional, retrospective, longitudinal study with 36 months of follow-up using electronic medical records (EMRs) from primary care centers, of patients aged 18+ years who began a new treatment with an opioid drug in usual practice for chronic pain due to osteoarthritis. Health/non-health resource utilization and costs, treatment adherence, pain change, cognitive functioning, and dependence for basic activities of daily living (BADL) were assessed. Results: A total of 38,539 EMRs [mean age (SD); 70.8 (14.3) years, 72.3% female; 53.3% hip/knee, 25.0% spine, and 21.7% other sites] were recruited. A total of 19.1% of patients remained on initial opioid at 36 months, without significant differences by osteoarthritis site ( p = 0.125). Mean total adjusted cost was €17,915, with 27.7% corresponding to healthcare resources and 72.3% to lost productivity. Hospital admissions for osteoarthritis-related surgical interventions accounted for 15.8% of total healthcare cost. A slight mean pain reduction was observed: –1.3 points, –16.9%, p < 0.001, with increases in cognitive deficit (+3.3%, p < 0.001) and moderate to total dependence for BADL (+15.6%, p < 0.001) in a median duration of opioid use of 203 days (IQR: 89–696). Conclusions: In real-world practice in Spain, opioid use in osteoarthritis was high, but with low adherence. There were meaningful increases in resource use and costs for the National Health System. Pain reduction was modest, whereas cognitive impairment and dependence for BADL increased significantly.

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

“…Secondary analysis of a non-interventional, multicenter, longitudinal, retrospective study using electronic medical records (EMR): the Outcomes in Patients usIng Opioids In Painful Disorders in Spain (OPIOIDS) study, whose design, methods, and main findings are available elsewhere [ 23 ]. The study population was obtained from the health records of health providers unified in the BIG-PAC anonymized database, registered with the European Network of Centers for Pharmacoepidemiology and Pharmacovigilance (ENCePP ® ) which is coordinated by the European Medicines Agency ( http://www.encepp.eu/encepp/viewResource.htm?id=29236 ).…”

“…1 ). To estimate the number of patients in 2018, the incidence of initiating an opioid therapy with either a weak or strong opioid in 2010–2015 as shown by the OPIOIDS study [ 23 ] was projected onto the Spanish population aged 18 years or more in 2018, fitting the best trend analysis and corresponding mathematical equation (Supplementary Fig. S1 and Table S2).…”

“…Registered in OPIOIDS study [23] Projections OA osteoarthritis Primary care medical visits were the most widely used resource and the only one that decreased significantly after the initiation of opioids, while other health resource utilization, particularly specialist visits in patients on strong opioids, although not hospital stays, laboratory tests, or axial tomography, increased significantly when patients were receiving weak or strong opioids, although the magnitude of the increases in terms of the effect size, according to Kazis et al, was small [41]. Nonetheless, our frequency data were consistent with those reported by the EPISER study (28.9%), which also found that medical visits were the healthcare resource most used by patients with rheumatic diseases [42].…”

“…However, refractory pain (pain that cannot be adequately controlled despite non-pharmacological measurements and pharmacological drugs) persists in a percentage of patients after using combinations or sequential treatment with NSAIDs and opioids [ 20 , 21 ]. As in comparable countries, in Spain opioid use has increased in recent decades [ 22 ], although their efficacy in reducing pain is modest and they are accompanied by increased cognitive decline and dependence for activities of daily living, which results in an increase in the burden and cost of the disease for the Spanish National Health System (NHS) [ 23 ].…”

The burden of chronic pain for patients with osteoarthritis in Germany: a retrospective cohort study of claims data

“…It is clear from our findings that chronic pain is associated with substantial extra disease burden in patients with OA. While several papers have previously evaluated the cost of OA in patients taking opioids [26,27], and we note a recent study additionally reporting on HRU and costs in patients with OA by pain severity episodes [28], we believe that our study uniquely assesses the additional burden of chronic pain as defined by opioid use or diagnosis. As the first assessment of the cost burden of chronic pain in German patients, this study provides a useful estimate of the extra cost burden of chronic pain.…”