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Impact of opioid-induced constipation on healthcare resource utilization and costs for cancer pain patients receiving continuous opioid therapy

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Abstract

Purpose

Opioid therapy is often associated with adverse effects, including opioid-induced constipation (OIC), in patients receiving opioids for cancer pain. This retrospective observational cohort study evaluated healthcare utilization and costs during the first year after initiating opioid therapy among cancer patients with (cohort 1) and without (cohort 2) constipation.

Methods

This study used administrative claims data from the HealthCore Integrated Research Environment between January 1, 2006, and April 30, 2014. Eligible patients included adults ≥ 18 years with a diagnosis of cancer who initiated continuous opioid therapy (≥ 30 days). Propensity scores were used to match patients with constipation in a 1:1 ratio to those without constipation. Generalized linear models were used to evaluate healthcare utilization and costs during the 12 months after initiating opioid therapy.

Results

After matching, 1369 patients were included in each cohort. Patients with constipation were more than twice as likely as those without constipation to have an all-cause inpatient hospitalization (odds ratio [95% confidence interval (CI)], 2.47 [2.11–2.90]), or pain-related hospitalization (2.15 [1.82–2.54]) during the 12 months after initiating therapy. Mean unadjusted overall healthcare costs during the first 12 months post-index were $21,629 (95% CI, $14,850–$29,018) higher for patients with constipation than for those without constipation. For patients with constipation, total mean (SD) constipation-related costs were $9196 ($26,896).

Conclusions

These results suggest that OIC is associated with significantly increased healthcare and economic burden in cancer pain patients and that early and ongoing recognition and management of OIC are unmet needs in this population.

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Acknowledgments

The authors thank Megan Knagge, PhD, of MedErgy (Yardley, PA, USA) for providing medical writing support, which was in accordance with Good Publication Practice (GPP3) guidelines and funded by AstraZeneca (Wilmington, DE, USA).

Funding

This study was supported by AstraZeneca Pharmaceuticals, LP (Wilmington, DE).

Author information

Authors and Affiliations

  1. School of Medicine, University of Utah Pain Research and Management Centers, 615 Arapeen Drive, Suite 200, Salt Lake City, UT, 84108, USA

    Perry G. Fine

  2. HealthCore, Inc., Wilmington, DE, USA

    Yen-Wen Chen

  3. US Medical Affairs, AstraZeneca, Wilmington, DE, USA

    Eric Wittbrodt & Catherine Datto

Authors
  1. Perry G. Fine
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  2. Yen-Wen Chen
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  3. Eric Wittbrodt
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  4. Catherine Datto
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Corresponding author

Correspondence to Perry G. Fine.

Ethics declarations

For this retrospective study based on administrative data, formal consent was not required. All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki.

Conflict of interest

P.G.F. is on the Board of Directors of Magellan Health, and he has received consulting fees from AstraZeneca Pharmaceuticals, Capital Caring, and Endo Pharmaceuticals within the last 36 months. Y.-W.C. is an employee of HealthCore, Inc. E.W. and C.D. are employees of AstraZeneca.

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Fine, P.G., Chen, YW., Wittbrodt, E. et al. Impact of opioid-induced constipation on healthcare resource utilization and costs for cancer pain patients receiving continuous opioid therapy. Support Care Cancer 27, 687–696 (2019). https://doi.org/10.1007/s00520-018-4366-z

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  • DOI: https://doi.org/10.1007/s00520-018-4366-z

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