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Association between Vaso-occlusive Crises and Opioid Prescriptions among Patients with Sickle Cell Disease: A Retrospective Claims-based Study.
J Health Econ Outcomes Res. 2020; 7(1):94-101.JH

Abstract

Background/Objectives

Among sickle cell disease (SCD) patients, vaso-occlusive crises (VOCs) are recurrent and unpredictable attacks of acute pain. These pain crises are often treated with analgesics, including opioids, which have been associated with misuse and overdose. The aim of this study was to examine the association between VOC events and opioid use and assess the association between opioid prescriptions and health care resource utilization among SCD patients.

Methods

This was a retrospective cohort study using Texas Medicaid medical and prescription claims between September 2011 and August 2016. The index date was the first SCD diagnosis. Patients (2-63 years) with at least one inpatient or two outpatient SCD diagnoses, who were continuously enrolled during 12 months postindex, were included in the study. The primary outcome was number of opioid prescriptions, while the independent variable was number of VOC events. Covariates included age, gender, nonopioid medication use, nonstudy SCD-related medication (penicillin and folic acid) use, evidence of blood transfusions, number of SCD-related complications, number of SCD-related comorbid conditions, and Charlson Comorbidity Index score. Negative binomial regression analysis was used to address study objectives.

Results

Of 3368 included patients, 1978 (58.7%) had at least one opioid prescription with a mean of 4.2 (SD=7.2). Overall, 2071 (61.5%) had at least one VOC event with an average of 2.9 (SD=4.4). The results from the negative binomial regression showed that for every increase in VOC events, the number of opioid prescriptions increased by 9.5% (Incidence rate ratio=1.095, 95% CI: 1.078-1.111; P ≤ 0.0001). Other significant covariates associated with higher opioid use included age (13 and older compared to 2-12) and increase in the number of nonopioid pain medications, nonstudy SCD-related medications, and SCD-related complications.

Conclusions

The majority of SCD patients had at least one VOC event and were prescribed opioids during the 12-month study period. We found that each VOC event was associated with a 9.5% increase in the use of opioids. SCD guidelines recommend opioids for the treatment of VOC-related pain. Payers and providers should be aware of opioid use in this population, consider appropriate VOC prevention measures, and provide SCD patients with access to appropriate pain management.

Authors+Show Affiliations

The University of Texas at El Paso, School of Pharmacy, El Paso, TX.The University of Texas at Austin, College of Pharmacy, Austin, TX.The University of Texas at Austin, College of Pharmacy, Austin, TX.Novartis Pharmaceuticals Corporation, US Oncology, East Hanover, NJ.Novartis Pharmaceuticals Corporation, US Oncology, East Hanover, NJ.Augusta University, Center for Blood Disorders, Augusta, GA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32685602

Citation

Kang, Hyeun Ah, et al. "Association Between Vaso-occlusive Crises and Opioid Prescriptions Among Patients With Sickle Cell Disease: a Retrospective Claims-based Study." Journal of Health Economics and Outcomes Research, vol. 7, no. 1, 2020, pp. 94-101.
Kang HA, Barner JC, Richards KM, et al. Association between Vaso-occlusive Crises and Opioid Prescriptions among Patients with Sickle Cell Disease: A Retrospective Claims-based Study. J Health Econ Outcomes Res. 2020;7(1):94-101.
Kang, H. A., Barner, J. C., Richards, K. M., Bhor, M., Paulose, J., & Kutlar, A. (2020). Association between Vaso-occlusive Crises and Opioid Prescriptions among Patients with Sickle Cell Disease: A Retrospective Claims-based Study. Journal of Health Economics and Outcomes Research, 7(1), 94-101. https://doi.org/10.36469/jheor.2020.13348
Kang HA, et al. Association Between Vaso-occlusive Crises and Opioid Prescriptions Among Patients With Sickle Cell Disease: a Retrospective Claims-based Study. J Health Econ Outcomes Res. 2020;7(1):94-101. PubMed PMID: 32685602.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between Vaso-occlusive Crises and Opioid Prescriptions among Patients with Sickle Cell Disease: A Retrospective Claims-based Study. AU - Kang,Hyeun Ah, AU - Barner,Jamie C, AU - Richards,Kristin M, AU - Bhor,Menaka, AU - Paulose,Jincy, AU - Kutlar,Abdullah, Y1 - 2020/06/26/ PY - 2020/03/16/received PY - 2020/05/21/revised PY - 2020/05/28/accepted PY - 2020/7/21/entrez PY - 2020/7/21/pubmed PY - 2020/7/21/medline KW - VOC KW - opioids KW - pain crisis KW - sickle cell KW - sickle cell disease KW - vaso-occlusive crisis SP - 94 EP - 101 JF - Journal of health economics and outcomes research JO - J Health Econ Outcomes Res VL - 7 IS - 1 N2 - Background/Objectives: Among sickle cell disease (SCD) patients, vaso-occlusive crises (VOCs) are recurrent and unpredictable attacks of acute pain. These pain crises are often treated with analgesics, including opioids, which have been associated with misuse and overdose. The aim of this study was to examine the association between VOC events and opioid use and assess the association between opioid prescriptions and health care resource utilization among SCD patients. Methods: This was a retrospective cohort study using Texas Medicaid medical and prescription claims between September 2011 and August 2016. The index date was the first SCD diagnosis. Patients (2-63 years) with at least one inpatient or two outpatient SCD diagnoses, who were continuously enrolled during 12 months postindex, were included in the study. The primary outcome was number of opioid prescriptions, while the independent variable was number of VOC events. Covariates included age, gender, nonopioid medication use, nonstudy SCD-related medication (penicillin and folic acid) use, evidence of blood transfusions, number of SCD-related complications, number of SCD-related comorbid conditions, and Charlson Comorbidity Index score. Negative binomial regression analysis was used to address study objectives. Results: Of 3368 included patients, 1978 (58.7%) had at least one opioid prescription with a mean of 4.2 (SD=7.2). Overall, 2071 (61.5%) had at least one VOC event with an average of 2.9 (SD=4.4). The results from the negative binomial regression showed that for every increase in VOC events, the number of opioid prescriptions increased by 9.5% (Incidence rate ratio=1.095, 95% CI: 1.078-1.111; P ≤ 0.0001). Other significant covariates associated with higher opioid use included age (13 and older compared to 2-12) and increase in the number of nonopioid pain medications, nonstudy SCD-related medications, and SCD-related complications. Conclusions: The majority of SCD patients had at least one VOC event and were prescribed opioids during the 12-month study period. We found that each VOC event was associated with a 9.5% increase in the use of opioids. SCD guidelines recommend opioids for the treatment of VOC-related pain. Payers and providers should be aware of opioid use in this population, consider appropriate VOC prevention measures, and provide SCD patients with access to appropriate pain management. SN - 2327-2236 UR - https://www.unboundmedicine.com/medline/citation/32685602/Association_between_Vaso_occlusive_Crises_and_Opioid_Prescriptions_among_Patients_with_Sickle_Cell_Disease:_A_Retrospective_Claims_based_Study_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32685602/ DB - PRIME DP - Unbound Medicine ER -
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