Opioid utilization patterns among medicare patients with diabetic peripheral neuropathy

Area of Science:

• Pharmacology
• Geriatrics
• Pain Management

Background:

• Diabetic peripheral neuropathy (DPN) significantly impacts type 2 diabetes patients, causing severe pain and high healthcare costs, particularly for those aged 65 and older.
• Elderly patients with DPN incur substantial economic burdens due to increased healthcare utilization, with costs reaching billions annually.

Purpose of the Study:

• To analyze real-world utilization patterns of long-acting opioids (LAOs) and chronic short-acting opioids (SAOs) in Medicare enrollees (≥65 years) with painful DPN.
• To identify areas for optimizing the management of opioid-treated elderly patients experiencing painful DPN.

Main Methods:

• Retrospective analysis of pharmacy claims data from MarketScan databases using Chronic Opioid Medication Use Evaluation (MUE) software.
• Inclusion criteria: Patients aged ≥65 with painful DPN (≥2 ICD-9 codes) and ≥1 claim for LAO or chronic SAO (≥60 days continuous therapy) in 2009.
• Data extraction covered 12 months, focusing on various opioid utilization measures.

Main Results:

• 1448 elderly patients with painful DPN were analyzed, showing high utilization of SAOs (62%) with infrequent concurrent LAO use (11%).
• Fentanyl transdermal, oxycodone CR, and morphine CR/ER/SR were the most common LAOs. Notably, patients exceeded recommended LAO doses.
• 15.2% used multiple pharmacies for prescriptions, 1.6% used high-dose acetaminophen, and concomitant use of opioids with GI medications was prevalent.

Conclusions:

• Elderly patients with painful DPN frequently use LAO doses exceeding package insert recommendations.
• Significant findings include high-dose acetaminophen use, multi-pharmacy prescription filling, and concurrent opioid/GI medication use.
• Utilizing software like Opioid MUE can aid healthcare decision-makers and payers in monitoring and managing opioid utilization in this vulnerable population.