Association between Vaso-occlusive Crises and Opioid Prescriptions among Patients with Sickle Cell Disease: A Retrospective Claims-based Study.
Association between Vaso-occlusive Crises and Opioid Prescriptions among Patients with Sickle Cell Disease: A Retrospective Claims-based Study.
复制标题
DOI：
10.36469/jheor.2020.13348
复制
发表时间：
2020-01-01
影响因子：
--
通讯作者：
Kutlar, Abdullah
中科院分区：
文献类型：
--
作者：
Kang, Hyeun Ah;Barner, Jamie C;Kutlar, Abdullah
背景/说明：在镰状细胞病（SCD）患者中，血管闭塞性危象（VOC）是急性疼痛的复发性和不可预测的发作。这些疼痛危机通常用镇痛剂治疗，包括阿片类药物，这与滥用和过量有关。本研究的目的是检查挥发性有机化合物事件和阿片类药物使用之间的关联，并评估阿片类药物处方和医疗资源利用之间的关联SCD patients.METHODS：这是一项回顾性队列研究，使用得克萨斯州医疗补助医疗和处方索赔2011年9月至2016年8月。索引日期为首次SCD诊断。在索引后12个月内连续入组的至少有1例住院或2例门诊SCD诊断的患者（2-63岁）纳入研究。主要结局是阿片类药物处方数量，而自变量是VOC事件数量。协变量包括年龄、性别、非阿片类药物使用、非研究SCD相关药物（青霉素和叶酸）使用、输血证据、SCD相关并发症数量、SCD相关合并症数量和Charlson合并症指数评分。负二项回归分析被用来解决研究objectives.RESULTS：3368包括患者，1978（58.7%）有至少一个阿片类药物处方，平均4.2（SD=7.2）。总体而言，2071例（61.5%）患者至少发生1起VOC事件，平均2.9起（SD=4.4）。负二项回归结果显示，VOC事件每增加一次，阿片类药物处方数量就增加9.5%（发生率比=1.095，95%CI：1.078-1.111; P ≤ 0.0001）。与阿片类药物使用率较高相关的其他显著协变量包括年龄（13岁及以上，2-12岁）和非阿片类止痛药、非研究SCD相关药物和SCD相关并发症的数量增加。结论：大多数SCD患者至少有一次VOC事件，并在12个月的研究期间服用阿片类药物。我们发现，每个VOC事件与阿片类药物使用增加9.5%相关。SCD指南推荐阿片类药物用于治疗VOC相关疼痛。支付者和提供者应了解阿片类药物在这一人群中的使用，考虑适当的VOC预防措施，并为SCD患者提供适当的疼痛管理。
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.