CHRONIC OPIOID THERAPY-ASSOCIATED PRODUCTIVITY LOSSES IN US WORKING OLDER ADULTS

摘要 最普遍的慢性疾病是慢性非癌性疼痛(CNCP)，在近40%的 处于工作年龄的老年人。尽管缺乏关于阿片类药物疗效和有效性的确凿证据 对于CNCP，以及目前可用的有效的非阿片类药物治疗，许多患者仍在接受阿片类药物治疗。 老年人比中年人更有可能使用处方阿片类药物，许多患有CNCP的成年人 急性期开始服用阿片类药物，过渡到长期阿片类药物治疗(COT)，健康状况不佳 后果。我们之前的研究已经表明，这种转变与相关的不良健康 后果，可以使用一系列可修改的因素来预测，包括阿片类药物方案的特点。 在阿片类药物方案中加入共同处方的苯二氮卓类药物会进一步增加这些风险。还有，劳工 劳动力正在老龄化，55岁及以上的成年人中有40%正在工作或寻找工作。与健康相关的因素 处于工作年龄的老年人除了直接医疗费用外，还会给雇主和雇员带来负担。 与治疗某种疾病有关的。这项建议的目的是量化生产力损失。 与过渡到COT相关，使用或不使用同时使用苯二氮类药物治疗，在成长中的 美国劳动力的一部分，即处于工作年龄的老年人。基于Truven的回顾性队列设计 Health MarketScan®商业索赔和遭遇数据库与Heath and Productive链接 管理(HPM)数据将用于(1)确定从急性向COT过渡的主要预测因素 在没有患癌症的劳动年龄老年人(50岁-)中，(2)评估与此相关的生产力损失 在没有癌症的工作年龄老年人中，从急性过渡到COT，以及(3)评估 工作年龄的老年人在婴儿床上同时服用苯二氮卓类药物导致的生产力损失 没有癌症。通过提供与COT相关的生产力损失估计，利益相关者包括 患者、医疗保健提供者、医疗保健付款人和雇主可以更好地量化维护的价值 一支健康的劳动力队伍，并证明增加早期风险缓解工作的支出是合理的。通过这项研究，我们努力 通过评估减少处方药滥用负担对工作年龄美国老年人的影响 安全有效地使用药物，特别是阿片类药物。

Abstract The most pervasive chronic condition, chronic non-cancer pain (CNCP), is prevalent in up to nearly 40% of working-aged older adults. Despite lack of robust evidence regarding the efficacy and effectiveness of opioids for CNCP, and currently-available effective non-opioid treatments, many patients still receive opioid therapy. Older adults are more likely to use prescription opioids than middle aged adults, and many adults with CNCP who were initiated on opioids acutely, transition into chronic opioid therapy (COT) with adverse health consequences. Our previous research has shown this transition, with the associated adverse health consequences, can be predicted using a set of modifiable factors including opioid regimen characteristics. Adding co-prescribed benzodiazepines to the opioid regimen can further increase these risks. Also, the labor force is aging and 40% of adults 55 years and older are working or looking for work. Health related factors of working-age older adults can burden both the employer and employee beyond the direct medical costs associated with treating a condition. The purpose of this proposal is to quantify the productivity losses associated with a transition to COT, with or without concurrent benzodiazepine therapy, among a growing segment of the US workforce, working-aged older adults. A retrospective cohort design based on Truven Health MarketScan® Commercial Claims and Encounters Database linked with Heath and Productivity Management (HPM) data will be used to (1) identify leading predictors of transitioning from acute to COT among working-aged older adults (ages 50–64) without cancer, (2) evaluate the productivity losses associated with transitioning from acute to COT in working-aged older adults without cancer, and (3) evaluate the productivity losses associated with co-prescribing of a benzodiazepine to COT in working-aged older adults without cancer. By providing estimates for losses in productivity associated with COT, stakeholders including patients, health care providers, health care payers, and employers can better quantify the value of maintaining a healthy workforce and justify increased spending on early risk mitigation efforts. With this research we strive to reduce the impact of prescription drug misuse burden in working-age older Americans through evaluation of safe and effective use of medications, particularly opioids.