Economic burden of opioid-induced constipation: An analysis of commercially insured patients without cancer in the United States

Economic burden of opioid-induced constipation: An analysis of commercially insured patients without cancer in the United States

Background:

Opioid-induced constipation (OIC) is a significant adverse effect of opioid use, characterized by abdominal tenderness, bloating, and hard stools.¹ Among patients receiving opioids for non-cancer pain, OIC may develop in approximately half, and given OIC typically persists for the duration of opioid treatment, it can have considerable negative impacts on daily activity, productivity, and social interaction.^1,2 Although prior studies have estimated the healthcare costs associated with OIC among opioid users,^3-7 there is limited evidence assessing OIC among continuous opioid users.

Purpose/Objectives:

The current study compared the healthcare resource utilization (HRU) and healthcare costs between continuously treated, commercially insured non-cancer patients with OIC and those without OIC in the United States (US).

Method:

IQVIA PharMetrics® Plus claims (10/2015-12/2021) were used to identify patients (18-64 years) with ≥90 days continuous opioid use. Patients were categorized into OIC or No OIC cohorts, based on presence/absence of an OIC indicator (constipation diagnosis or prescription fill for constipation treatment). The index date was the first OIC indicator within an eligible continuous opioid use episode (OIC cohort) or a randomly selected date (No OIC cohort) to match the time from continuous opioid use episode start to the index date in the OIC cohort. Within the cohorts, patients without cancer (no diagnoses during the 3-month baseline or 6-month study period following the index date) were identified. Cohorts were entropy-balanced. Total healthcare costs during the study period were compared using mean differences; HRU was assessed using incidence rate ratios (IRRs) and odds ratios (ORs). For both outcomes, 95% confidence intervals (CIs) and p-values were reported.

Results:

Characteristics among the OIC (N=113,012) and No OIC cohorts (N=767,131) were similar post-balancing. Total healthcare costs were significantly higher in the OIC versus No OIC cohort (mean difference [95% CI]=$19,034 [18,425-19,643], p< 0.001), driven by medical costs (mean difference [95% CI]=$16,724 [16,142-17,307], p< 0.001). Pharmacy costs were also significantly higher in the OIC versus No OIC cohort (mean difference [95% CI]=$2,309 [2,163-2,455], p< 0.001). HRU was significantly higher in the OIC than No OIC cohort, with higher odds of outpatient (OR [95% CI]=6.5 [6.1-7.0]) and emergency room visits (OR [95% CI]=1.8 [1.7-1.8]), and incidence of inpatient admissions (IRR [95% CI]=2.2 [2.1-2.2]; all p< 0.001).

Conclusions: This real-world study demonstrates the substantial economic burden associated with OIC among continuous opioid users without cancer. It is important to consider the economic consequences of OIC among patients without cancer who rely on opioids for pain management, as they represent a substantial portion of the population. Further, this study provides insights on a population with particularly long periods of opioid use.

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