Use and Costs of Prescription Medications and Alternative Treatments in Patients with Osteoarthritis and Chronic Low Back Pain in Community-Based Settings
Disclosures:: This research was funded by Pfizer Inc. Dr. Gore is Principal Consultant and Kei-Sing Tai is Principal Statistician, at Avalon Health Solutions, Inc., and were paid consultants to Pfizer in connection with the development and execution of both this article and the research it describes. Dr. Gore also owns stock in Pfizer. Dr. Sadosky is an employee of Pfizer and owns stock in Pfizer. Dr. Leslie was paid an honorarium by Avalon Health Solutions, Inc. for his participation in this research and for his review of and input for this article. Dr. Leslie has also performed consulting for Kurron Bermuda Ltd. Dr. Stacey has received consulting fees from Pfizer, Boehringer-Ingelheim, Endo Pharmaceuticals, and AstraZeneca. He has received research support from AstraZeneca, Abbott, and Pfizer. Dr. Stacey was not paid for his participation in this research and for his review of and input for this article.
Abstract
Objective: To evaluate the use and direct medical costs of pharmacologic and alternative treatments for patients with osteoarthritis (OA) and chronic low back pain (CLBP).
Methods: The LifeLink™ Health Plan Claims Database was used to identify patients ≥18 years old, diagnosed with OA (N = 112,951) or CLBP (N = 101,294). Of these patients, 64,085 with OA and 47,386 with CLBP received pain-related treatments during CY2008 and were selected for inclusion. For patients in both cohorts, pharmacologic and alternative treatments, and direct medical costs were examined during CY2008.
Results: Opioids were the most frequently prescribed medication (>70%) in both groups, followed by nonselective nonsteroidal anti-inflammatory drugs (>50%). Over 30% received antidepressants, >20% received benzodiazepines, and 15% in each group received sedative hypnotics. Use of alternative treatments was as follows: chiropractor, OA 11%, CLBP 34%; physical therapy, 20% in both groups; transcutaneous electrical nerve stimulations (TENS), OA 14%, CLBP 22%; acupuncture, hydrotherapy, massage therapy, and biofeedback, <3% in both groups. Mean (SD) total healthcare costs among these patients were, OA: $15,638 ($22,595); CLBP: $11,829 ($20,035). Pharmacologic therapies accounted for approximately 20% of these costs, whereas alternative treatments accounted for only 3% to 4% of the total costs.
Conclusions: Patients with OA and CLBP used a variety of pain-related and adjunctive medications. Although, alternative treatments are widely recommended, we found limited use of several of these in clinical practice, potentially due to the source of our data (commercial claims). Further research is needed to ascertain the extent to which such therapies contribute to the total costs of OA and CLBP management.
