Therapy switching in patients receiving long-acting opioids

Area of Science:

• Pain management
• Pharmacoeconomics
• Clinical pharmacy

Background:

• Long-acting opioid therapy switching patterns are not well-documented.
• Understanding these patterns is crucial for optimizing patient care and managing healthcare resources.
• Opioid analgesics are widely prescribed for chronic pain management.

Purpose of the Study:

• To compare therapy switching rates among patients initiating treatment with controlled-release (CR) oxycodone, transdermal fentanyl, or CR morphine sulfate.
• To analyze the association between therapy switching and total healthcare charges.

Main Methods:

• Retrospective analysis of a US healthcare claims database.
• Inclusion of patients initiating CR oxycodone, transdermal fentanyl, or CR morphine sulfate between July 1998 and December 1999.
• Comparison of therapy switching incidence and estimation of healthcare charges over a 6-month follow-up period.

Main Results:

• Patients without cancer initiating CR oxycodone (10.6%) or transdermal fentanyl (19.0%) switched therapy less frequently than those on CR morphine sulfate (26.0%).
• For patients with cancer, switching rates were similar across all three formulations (23.8% to 29.8%).
• Total healthcare charges were significantly higher for patients who switched therapy compared to those who did not ($23,965 vs $14,299 for non-cancer patients; $58,259 vs $39,618 for cancer patients).

Conclusions:

• Controlled-release (CR) oxycodone and transdermal fentanyl appear to be associated with lower therapy switching rates compared to CR morphine sulfate in non-cancer patients.
• Therapy switching in long-acting opioid treatment is linked to increased healthcare expenditures.
• These findings have implications for opioid selection and cost-effective pain management strategies.