Projecting the cost, utilization, and patient care impact of prescribing extended release non-abuse-deterrent opioids to chronic pain patients
DOI:
https://doi.org/10.5055/jom.2017.0398Keywords:
opioid, abuse, abuse-deterrent formulation, savingsAbstract
Objectives: To estimate healthcare resource utilization, associated costs, and number needed to harm (NNH) from a physician's decision to prescribe extended-release (ER) non-abuse-deterrent opioids (non-ADO) as compared to ER ADOs in a chronic pain population.
Design: A 12-month probabilistic simulation model was developed to estimate the reduction of misuse and/or abuse from a physician's prescribing decisions for 10,000 patients. Model inputs included probabilities for opioid misuse and/ or abuse-related events, opioid discontinuation, and switching from ADO to non- ADO. Estimated reductions in abuse associated with ADOs were obtained from positive subjective measures using human abuse liability studies. The model was run separately for commercial, Medicare, Medicaid, and Veterans Administration (VA) populations. The difference in healthcare resource utilization and associated costs (2015 USD) between the ADO and non-ADO simulations was calculated. NNH for non-ADO was also calculated.
Results: Misuse and/or abuse-related events for patients prescribed ER non-ADOs ranged from 223−1,410 and associated costs ranged from $20−$98 per patient for commercial and Medicare populations, respectively. Prescribing ER ADOs were associated with 87, 289, 264, and 417 fewer misuse and/or abuse−related events, saving $8, $35, $21, and $29 per patient in commercial, VA, Medicaid, and Medicare populations, respectively. NNH ranged from 185 in the commercial population to 40 in the Medicare population. Results were sensitive to decreases in the probability of misuse and/or abuse events but showed reductions.
Conclusions: A physician's decision to prescribe ER ADOs could lead to large reductions in misuse and/or abuse-related events and associated costs across many patient populations.
References
Centers for Disease Control and Prevention: Understanding the Epidemic. 2015. Available at http://www.cdc.gov/drugoverdose/epidemic/. Accessed April 22, 2016.
Center for Behavioral Health Statistics and Quality: Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). 2015. Available at http://www.samhsa.gov/data/. Accessed December 15, 2015.
Centers for Disease Control and Prevention, Prescription Opioid Overdose Data. 2015. Available at http://www.cdc.gov/drugoverdose/data/overdose.html. Accessed April 22, 2016.
Substance Abuse and Mental Health Services Administration: Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits, Table 2. Selected Substances Involved in Drug-Related Emergency Department (ED) Visits for Misuse or Abuse of Drugs: 2004, 2009, 2011. Available at http://archive.samhsa.gov/data/2k13/DAWN127/sr127-DAWN-highlights.htm. Accessed December 15, 2015.
Birnbaum HG, White AG, Schiller M, et al.: Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med. 2011; 12(4): 657-667.
Hansen RN, Oster G, Edelsberg J, et al.: Economic costs of nonmedical use of prescription opioids. The Clinical Journal of Pain. 2011; 27(3): 194-202.
Centers for Disease Control and Prevention: Overdose Prevention. 2015. Available at http://www.cdc.gov/drugoverdose/opioids/odprevention.html. Accessed April 22, 2016.
U.S. Food and Drug Administration: Timeline of Selected FDA Activities and Significant Events Addressing Opioid Misuse
and Abuse. 2015. Available at http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM332288.pdf. Accessed December 15, 2015.
Bartelson BB, Le Lait C, Dart R, et al.: Medical outcomes associated with unintended routes of prescription opioid Abuse. Postgraduate Med. 2015; 127: S54-S55.
Rossiter LF, Kirson NY, Shei A, et al.: Medical cost savings associated with an extended-release opioid with abuse-deterrent technology in the US. J Med Econ. 2014; 17(4): 279-287.
Severtson SG, Bartelson BB, Davis JM, et al.: Reduced abuse, therapeutic errors, and diversion following reformulation of extended-release oxycodone in 2010. J Pain. 2013; 14(10): 1122-1130.
White AG, Birnbaum HG, Rothman DB, et al.: Development of a budget-impact model to quantify potential cost savings from prescription opioids designed to deter abuse or ease of extraction. ApplHealth Econ Health Policy. 2009; 7(1): 61-70.
White AG, LeCates J, Birnbaum HG, et al.: Positive Subjective Measures in Abuse Liability Studies and Real-World Non-Medical Use: Potential Impact of Abuse Deterrent Opioids on Rates of Non-Medical Use and Associated Health Care Costs. J Manage. 2015; 11(3): 199-210.
U.S. Food and Drug Administration: Highlights of Prescribing Information, Embeda. 2014. Available at http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022321s016lbl.pdf. Accessed December 15, 2015.
U.S. Food and Drug Administration: Highlights of Prescribing Information, Oxycontin. 2015. Available at http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022272s027lbl.pdf. Accessed December 15, 2015.
Roland CL, Joshi AV, Mardekian J, et al.: Prevalence and cost of diagnosed opioid abuse in privately insured population in the United States. J Opioid Manage. 2013; 9(3): 161-175.
Palmer RE, Carrell DC, Cronkite D, et al.: The prevalence of problem opioid use in patients receiving chronic opioid therapy: Computer-assisted review of electronic health record clinical notes. Pain J. 2015; 156: 1208-1214.
Oderda G, Roland CL, Stevens V, et al.: Prevalence and Direct Costs of Opioid Abuse in Medicare Beneficiaries. Presented at AMCP Nexus October 26-29, 2015 in Orlando, FL.
McAdam-Marx C, Roland CL, Cleveland J, et al.: Costs of opioid abuse and misuse determined from a Medicaid database. J Pain Palliative Care Pharmacother. 2010; Vol. 24(1): 5-18.
Baser O, Xie L, Mardekian J, et al.: Prevalence of Diagnosed Opioid Abuse and its Economic Burden in the Veterans Health Administration. Pain Practice. 2014; 14(5): 437-445.
Noble M, Treadwell JR, Tregear SJ, et al.: Long-term opioid management for chronic noncancer pain (review). Cochrane Database Syst Rev. 2010; 1(1).
Dunn KM, Saunders KW, Rutter CM, et al.: Opioid Prescriptions for Chronic Pain and Overdose. Annals Internal Med. 2010; 152(2), 85-92.
The IMS, National Prescription Audit™ (NPA) database. Accessed June 15, 2015.
HCUPnet 2013: National Statistics on All Stays: principal diagnosis - 304.00 (opioid dependence). 2013.
Smith M, Friedman B, Karaca Z, et al.: Predicting inpatient hospital payments in the United States: a retrospective analysis. BMC Health Services Res. 2015; 15:372.
Medicaid Drug Rebate Program: Medicaid.gov. 2015. Available at http://www.medicaid.gov/medicaid-chip-programinformation/by-topics/benefits/prescription-drugs/medicaiddrug-rebate-program.html. Accessed December 15, 2015.
U.S. Department of Veterans Affairs: Determining the Cost of Pharmaceuticals for a Cost-Effectiveness Analysis. 2015. Available at http://www.herc.research.va.gov/include/page.asp?id=pharmaceutical-costs. Accessed December 15, 2015.
NSDUH 2013: Figure 1.89B Nonmedical Use of Specific Pain Relievers in Lifetime, by Age Group: Percentages, 2012 and 2013.
Cicero TJ, Ellis MS , Harney J: Shifting patterns of prescription opioid and heroin abuse in the United States. New Eng. Med. 2015; 373(18): 1789-1790.
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