Monday, 20 May 2019

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Nonadherence is Costly for Patients in Pain

A comparative cohort study of patients with osteoarthritis (OA), gout, diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), and fibromyalgia (FM) shows that nonadherence to pain medications is high and leads to greater overall health care resource utilization and costs. 

Data was collected from a retrospective cohort study that used claims (MarketScan Commercial and Medicare Databases) between 2006-2013, identifying newly diagnosed with OA, GT, pDPN, PHN, or FM and identifed patients as either adherent, nonadherent, or "unsure" according to published pain management guidelines using a claims-based algorithm. 

The cohorts included patients with OA (n=441,465), gout (n=76,361), pDPN (n=10,645), PHN (n=4,010), and FM (n=150,321). Adherence to pain treatement guidelines was seen in:

  • 51.1% of OA
  • 25% of Gout
  • 59.5% of pDPN
  • 54.9% of PHN
  • 33.5% of FM

Those who were adherent had significantly (P < 0.05) fewer emergency department (ED) visits and lower proportions with hospitalizations or ED visits.

Adherent patients had significantly lower mean health care costs. Comparison of health care costs between adherent and nonadherent patients showed the following significant increases (all P < 0.001) in adjusted costs pre-index to postindex:

  • OA: $5,286 vs $9,532
  • Gout: $3,631 vs $7,873
  • pDPN: $9,578 vs $16,337
  • PHN: $2,975 vs $5,146
  • FM $2,911 vs $3,708

Pain medication nonadherence leads to significantly higher health care resource utilization and costs, suggesting a substantial need for education and other interventions that can lower this gap and its consequences.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

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