Do transdermal opioids affect the personal socioeconomic costs of healthcare access in an Australian rural pain population? A comparison with oral opioids

John S. Henshaw, MMed, FFPMANZCA; Judi Walker, PhD; Dom Geraghty, PhD

doi:10.5055/jom.2012.0105

Authors

John S. Henshaw, MMed, FFPMANZCA
Judi Walker, PhD
Dom Geraghty, PhD

DOI:

https://doi.org/10.5055/jom.2012.0105

Keywords:

chronic noncancer pain, transdermal opioids, healthcare access, socioeconomics, generalized estimating equations

Abstract

Objective: To determine whether there are differences in the personal socioeconomic costs of healthcare access between transdermal (TD) and oral opioid use in a rural population with chronic noncancer pain (CNCP).
Design: An observational longitudinal study, measuring change in the selfreported personal time and expense of healthcare access by route of opioid administration over time (monthly for 1 year). Subjects were opioid treated patients with CNCP from North West Tasmania, Australia. Subjects completed monthly datasheets by recording all personal healthcare access time and expense, together with the route(s) of opioid administration. The outcome measures of mean monthly healthcare time (MHT) and expense (MHE), by route of opioid administration, were analyzed using generalized estimating equations with robust standard errors.
Results: The details of 10,564 healthcare contacts from 198 subjects were obtained during the study. Total mean MHT with oral opioids was 3.76 hours (95% confidence interval [CI] = 2.21-5.32) and unchanged (p = 0.59) with TD opioids at 3.48 hours (95% CI = 2.23-4.72). Total mean MHE with oral opioids was AU$ 92.72 (95% CI = 51.21-134.24) and unchanged (p = 0.81) with TD opioids at AU$ 89.12 (95% CI = 54.53-123.71).
Conclusions: The personal socioeconomic costs of healthcare access for rural patients with CNCP are similar for TD and oral opioid use. The prolonged analgesic affect of TD opioids may be advantageous for rural population.

Author Biographies

John S. Henshaw, MMed, FFPMANZCA

Senior Lecturer, Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia.

Judi Walker, PhD

Head, School of Rural Health, Monash University, Melbourne, Victoria, Australia.

Dom Geraghty, PhD

Associate Professor, Deputy Associate Dean (Research), Faculty of Health Sciences, University of Tasmania, Burnie, Tasmania, Australia.

References

Pharmaceutical Benefits Advisory Committee: Buprenorphine, transdermal patch, 5 mg, 10 mg and 20 mg, Norspan®. Department of Health and Ageing, 2005. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/pbac-psd-buprenor phine. Accessed January 1, 2010.

NPS RADAR: Buprenorphine transdermal patches (Norspan) for chronic severe pain. National Prescribing Service, 2005. Available at http://www.npsradar.org.au/site.php?page=1&content=/npsradar/content/buprenorphine.html. Accessed January 1, 2010.

Pharmaceutical Benefits Advisory Committee: Fentanyl, transdermal patch, Durogesic® 12/25/50/75/100. Department of Health and Ageing, 2006. Available at http://www.health.gov. au/internet/main/publishing.nsf/Content/pbac-psd-fentanylpatch- mar06. Accessed January 1, 2010.

NPS RADAR: Fentanyl patches (Durogesic) for chronic pain. National Prescribing Service, 2006. Available at http://www.nps. org.au/health_professionals/publications/nps_radar/2006/augu st_2006/fentanyl_patches. Accessed January 1, 2010.

DHHS: Protocol for Opioid Prescribing in Tasmania. 2008. Available at http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0004/77701/Protocol_for_prescribing_opioids_in_Tasmania.pdf. Accessed December 31, 2010.

Hunter Integrated Pain Service: Opioid use in persistent pain. 2011. Available at http://www.hnehealth.nsw.gov.au/__data/assets/pdf_file/0007/76039/opioid_use_Nov_2010_2.pdf. Accessed December 31, 2011.

Henshaw JS: Do transdermal opioids reduce healthcare use in an Australian rural pain population? A comparison with oral opioids. J Opioid Manag. 2011; 7(2): 135-144.

AIHW: Australian health expenditure by remoteness: A comparison of remote, regional and city health expenditure. Australian Institute of Health and Welfare, 2011. Available at www.aihw.gov.au/publication-detail/?id6442475421. Accessed January 3, 2011.

Australian Bureau of Statistics: 3235.0–Population by age and sex, regions of Australia. 2008. Available at http://www.abs.gov. au/ausstats/abs@.nsf/Products/3235.0~2008~Main+Features~ Tasmania?OpenDocument. Accessed January 1, 2010.

Cradle Coast Authority: Cradle coast region, Tasmania. 2005. Available at http://www.cradlecoast.com/pdf/cradlecoast/00375_Profile-Intro.pdf. Accessed January 1, 2010.

Australian Bureau of Statistics: Socio-economic indexes for areas (SEIFA), Australia. 2006. Available at http://www.abs.gov. au/AUSSTATS/abs@.nsf/Lookup/2033.0.55.001Main+Features 12006?OpenDocument. Accessed January 1, 2010.

Guidelines for dispensing of medicines, Section 11, Pharmacists’ Workloads. Pharmacy Board of Australia, 2010. Available at http://www.pharmacyboard.gov.au/Codes-Guidelines. aspx. Accessed July 1, 2010.

Medicare Benefits Schedule: Department of Health and Ageing, 2010. Available at http://www.health.gov.au/internet/mbsonline/publishing.nsf/Content/Medicare-Benefits-Schedule- MBS-1. Accessed July 1, 2010.

Bulk Billing FAQ: Medicare Australia. 2010. Available at http://www.medicareaustralia.gov.au/provider/medicare/bulkbilling. jsp. Accessed July 1, 2010.

Overview of the PBS Safety Net: Medicare Australia. 2010. Available at http://www.medicareaustralia.gov.au/public/serv ices/scripts/pbs.jsp. Accessed July 1, 2010.

Twisk JWR: Applied Longitudinal Data Analysis for Epidemiology: A Practical Guide. Cambridge, UK: Cambridge University Press, 2003.

Stata/IC 11: StataCorp LP, College Station, TX 77845.

Report on the Audit of Health Workforce in Rural and Regional Australia. Australian Government Department of Health and Ageing, 2008. Available at http://www.health.gov. au/internet/main/publishing.nsf/Content/work-res-ruraud. Accessed January 1, 2010.

Australian Bureau of Statistics: 6306.0–Employee earnings and hours; 2009. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/6306.0/. Accessed October 30, 2010.

Centrelink: News for Seniors 78. 2009. Available at http://www.centrelink.gov.au/internet/internet.nsf/filestores/rt010_0907/$file/rt010_0907en.pdf. Accessed October 31, 2010.

WHO: Memberstates and medicines price information. 2010. Available at http://www.who.int/medicines/areas/access/ecofin_who_memberstates/en/index.html. Accessed December 31, 2011.