Systemic Opioid Prescribing Patterns and Total Cost of Care in Patients Initiating Spinal Cord Stimulation Therapy: A Retrospective Analysis
| Autor: | John A Hatheway, Eduardo M. Fraifeld, Christine N Ricker |
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| Rok vydání: | 2021 |
| Předmět: |
Total cost
Spinal cord stimulation Discontinuation Original Research Articles medicine Clinical endpoint Humans In patient Medical prescription Interventional Pain & Spine Medicine Section Practice Patterns Physicians' Retrospective Studies Spinal Cord Stimulation business.industry Chronic pain General Medicine medicine.disease Opioids Analgesics Opioid Anesthesiology and Pain Medicine Opioid Anesthesia Neurology (clinical) Chronic Pain business AcademicSubjects/MED00010 medicine.drug |
| Zdroj: | Pain Medicine: The Official Journal of the American Academy of Pain Medicine |
| ISSN: | 1526-4637 |
| Popis: | Background Few studies have evaluated patterns of systemic opioid use among patients initiating spinal cord stimulation therapy for chronic pain. This study evaluated systemic opioid discontinuation and/or dose reduction and total health care cost after the start of spinal cord stimulation therapy. Methods Using a commercial insurance claims database (2008–2017), we analyzed opioid utilization patterns in patients initiating spinal cord stimulation therapy over a 1-year baseline and 2-year follow-up. The primary end point was defined as either discontinuation (≥365-day gap between prescription fills or total days’ supply in follow-up ≤30 days) or ≥50% reduction in average daily morphine milligram equivalent dose. “Costs” were defined as total payer plus patient out-of-pocket payments. Results A total of 5,878 patients met the selection criteria. Of these, 152 (2.6%) showed no opioid prescription data at any point in the study period. Among patients with one or more prescriptions, 42.0% met the primary end point (22.0% discontinued, and 20.0% reduced their dose by 50% or more). Mean total adjusted costs were significantly reduced in years 1 and 2 of follow-up relative to baseline (excluding device insertion costs). The average time to breakeven when accounting for device trial and permanent insertion cost was 3.1 years among those who met the composite end point and 4.2 years among those who did not. Conclusions This analysis shows that among patients who continued spinal cord stimulation therapy for at least 2 years, a significant proportion were able to reduce and/or discontinue systemic opioid use, with costs after the start of therapy significantly reduced relative to baseline. |
| Databáze: | OpenAIRE |
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