Pharmaceutical Sciences ETDs

Publication Date

Fall 11-21-2018

Abstract

OBJECTIVES:COPD contributes significant morbidity and mortality worldwide and is currently the third leading cause of mortality in the United States. Chronic pain prevalence is high among COPD patients leading to a high rate of prescription opioid use. The potential impact of concurrent prescription opioid use on COPD maintenance medication adherence, COPD exacerbations, and total healthcare costs is not well understood. The study objectives were i) to assess the impact of prescription opioid use compared to no prescription opioid use on COPD maintenance medication adherence in 90, 180, 270, and 365-day follow-up periods, and ii) to assess the impact of long-term prescription opioid use (≥ 90 day prescription opioid supply in a one-year period) compared to no prescription opioid use on COPD maintenance medication adherence, COPD exacerbations and total healthcare costs in one-year follow-up period.

METHODS:Patients with COPD diagnosis were identified using ICD9-CM diagnosis codes and COPD maintenance medication prescription claims from the Truven Health MarketScan®Commercial Claims and Encounters Database from July 1, 2008 to December 31, 2009. COPD patients with prescription opioid claims were matched 1:1 to non-opioid users on baseline characteristics: age (±3 years), sex, severe and moderate COPD exacerbations, oxygen therapy use, short-acting beta2-agonist use, COPD maintenance medication adherence, and asthma status.Conditional multiple logistic regression, multiple negative binomial regression and generalized linear model with a gamma distribution and log-link function were used to identify the impact of long-term prescription opioid use versus no opioid use on COPD maintenance medication adherence [defined as proportion of days covered (PDC) ≥ 0.8], COPD exacerbations, total healthcare costs in a one-year period, respectively.

RESULTS:A total of 5,541 matched pairs of prescription opioid versus non-opioid users were identified. After adjusting for confounders, prescription opioid use was associated with statistically significantly lower odds of being adherent to COPD maintenance medications compared to no use of prescription opioids in all the four follow-up periods. Long-term prescription opioid users (n=566) had significantly higher mean Deyo-Charlson comorbidity scores (2.4±1.8 vs 1.7±1.2, p<0.0001), presence of comorbid chronic conditions (86.6% vs 76.3%, p<0.0001) and comorbid pain conditions (93.5% vs 70.7%, p<0.0001). After adjusting for confounders, long-term prescription opioid use was associated with 0.63 times (95% CI 0.46-0.88, p<0.01) lower odds of being adherent to COPD maintenance medications; and long-term prescription opioid users had higher adjusted mean all-cause total healthcare costs $23,996 (±$1,106.22) vs $13,947 (± $512.67), p<0.0001], compared to non-users of prescription opioids. Long-term prescription opioid use was not statistically significantly associated with severe or total (moderate + severe) COPD exacerbations.

CONCLUSIONS:Concurrent long-term use of prescription opioids may significantly lower COPD maintenance medication adherence which may translate into higher total all-cause healthcare costs and requires additional investigation.

Fourth Committee Member

Dr. Vishvas Garg

First Committee Member (Chair)

Dr. Matthew Borrego

Degree Name

Pharmaceutical Sciences

Second Committee Member

Dr. Melissa Roberts

Level of Degree

Doctoral

Third Committee Member

Dr. Patricia Marshik

Department Name

College of Pharmacy

Language

English

Document Type

Dissertation

Keywords

COPD, Opioid, Adherence, Exacerbation, Cost, MarketScan

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