The association of pain interference and opioid use with healthcare utilization and costs, and wage loss among adults with osteoarthritis in the United States

Zhao, Xiaohui; Shah, Drishti; Gandhi, Kavita; Wei, Wenhui; Dwibedi, Nilanjana; Webster, Lynn R.; Sambamoorthi, Usha

doi:10.1080/13696998.2019.1658590

Cited by 18 publications

(30 citation statements)

References 40 publications

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“…The strengths of this study include a relatively large sample (n = 841) of patients drawn from real-world clinical practice, and HCRU data directly related to OA pain severity. Other studies using administrative insurance claims are inexact in attributing HCRU to a specific diagnosis [12,35] and may underrepresent key factors. For example, we found that both measures of obesity were associated with pain severity, yet only 10% of patients had a diagnosis of obesity (6.3% to 12.7% of mild to severe pain patients) whereas rates using BMI ranged from 27% to 46.5% of mild to severe pain patients.…”

Section: Discussionmentioning

confidence: 99%

Pain severity and healthcare resource utilization in patients with osteoarthritis in the United States

Nalamachu¹,

Robinson

Viktrup

et al. 2020

Postgraduate Medicine

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Objective: To evaluate healthcare resource utilization (HCRU) by osteoarthritis (OA) pain severity. Methods: Cross-sectional surveys of US physicians and their patients were conducted between February and May 2017. Using the Numeric Rating Scale, patients were classified by self-reported pain intensity in the last week into mild (0-3), moderate (4-6), and severe (7-10) cohorts. Parameters assessed included clinical characteristics, HCRU, and current caregiver support. Descriptive statistics were obtained, and analysis of variance and chi-square tests were performed. Results: Patients (n = 841) were mostly female (60.9%) and white (77.8%), with mean age of 64.6 years. Patients reported mild (45.4%), moderate (35.9%), and severe (18.7%) OA pain. Mean number of affected joints varied by pain severity (range mild: 2.7 to severe: 3.6; p < 0.0001). Pain severity was associated with an increased number of physician-reported and patient-reported overall healthcare provider visits (HCPs; both p < 0.001). As pain increased, patients reported an increased need for mobility aids, accessibility modifications to homes, and help with daily activities due to functional disability. The number of imaging tests used to diagnose OA was similar across pain severity but varied when used for monitoring (X-rays: p < 0.0001; computerized tomography scans: p < 0.0447). Hospitalization rates for OA were low but were significantly associated with pain severity (mild: 4.9%; severe: 11.5%). Emergency department visits were infrequent but increasing pain severity was associated with more prior and planned surgeries. Conclusion: Greater current pain was associated with more prior HCRU including imaging for monitoring progression, HCP visits including more specialty care, hospitalizations, surgery/planned surgery, and loss of independence due to functional disability. Yet rates of hospitalizations and X-ray use were still sizable even among patients with mild pain. These cross-sectional findings warrant longitudinal assessment to further elucidate the impact of pain on HCRU.

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Section: Discussionmentioning

confidence: 99%

Pain severity and healthcare resource utilization in patients with osteoarthritis in the United States

Nalamachu¹,

Robinson

Viktrup

et al. 2020

Postgraduate Medicine

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“…40 Zhao et al pointed out that patients on opioids had greater resource use and total costs (healthcare: $13,595; non-healthcare: $2331). 41 These results suggest the need to evaluate alternative strategies for pain management. Our study provides similar results to those described previously, although non-health costs may be are proportionately higher, as patients on opioids may have greater disease severity.…”

Section: Study Groups (Osteoarthritis)mentioning

confidence: 99%

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

Sicras‐Mainar¹,

Tornero-Tornero

Negrín³

et al. 2020

Therapeutic Advances in Musculoskeletal

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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.

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“…The criteria used for identification of the evaluated population was the same as that in a previously published study on the association of opioid use and PIA with economic outcomes [15]. For inclusion in the analysis, adults (aged at least 18 years old) with OA were identified in the MEPS database for panels 15-19 from queries related to whether the respondent had ''OA'' in the full-year consolidated files or medical care encounters recorded in the medical condition files using the Clinical Classification Code (CCC) identifier 203.…”

Section: Data Source and Study Samplementioning

confidence: 99%

“…A previous cross-sectional study reported prescription opioid use in nearly one-third (30.3%) of individuals with OA and showed that opioid users had a higher disease burden compared with those without opioid use, even after adjusting for relevant demographic and clinical variables [14]. Furthermore, a study on the association of opioids and pain interference with activities (PIA) among individuals with OA showed that regardless of the level of PIA, opioid use increased the likelihood of specific categories of healthcare resource utilization including hospitalizations and emergency room visits, and was associated with higher costs relative to those not using opioids [15]. The purpose of the current study is to explore longitudinal assessment of the association of opioid use with PIA and functional limitations among adults with OA in the USA.…”

Section: Introductionmentioning

confidence: 99%

A Longitudinal Study of the Association of Opioid Use with Change in Pain Interference and Functional Limitations in a Nationally Representative Cohort of Adults with Osteoarthritis in the United States

et al. 2019

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Introduction: Real-world data are sparse on longitudinal associations of opioid use with pain interference with activities (PIA) and daily function with osteoarthritis (OA) in the USA. Methods: Data from the 2010-2015 Medical Expenditure Panel Surveys were analyzed for community-dwelling adults with OA. Opioid use patterns were defined as persistent, intermittent, and no use. Evaluated outcomes were a change in PIA and functional limitations (activities of daily living [ADL], instrumental ADL [IADL], social and work activities, and cognitive function). Multivariable regression analyses explored the association of persistent/ Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11353643.

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The association of pain interference and opioid use with healthcare utilization and costs, and wage loss among adults with osteoarthritis in the United States

Cited by 18 publications

References 40 publications

Pain severity and healthcare resource utilization in patients with osteoarthritis in the United States

Pain severity and healthcare resource utilization in patients with osteoarthritis in the United States

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

A Longitudinal Study of the Association of Opioid Use with Change in Pain Interference and Functional Limitations in a Nationally Representative Cohort of Adults with Osteoarthritis in the United States

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