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Medline ® Abstract for Reference 3

of 'Prevention and management of side effects in patients receiving opioids for chronic pain'

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Impact of constipation on opioid use patterns, health care resource utilization, and costs in cancer patients on opioid therapy.
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Candrilli SD, Davis KL, Iyer S
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J Pain Palliat Care Pharmacother. 2009;23(3):231.
 
Patterns of opioid use, resource utilization, and costs in cancer patients with and without constipation were compared using retrospective insurance claims data. Inclusion criteria were>=30 days of opioid use and continuous plan coverage for>or =6 months before and>or =12 months following first opioid claim (index date). Constipation was defined as>or =1 ICD-9-CM diagnosis codes in the range of 564.0x during the 12 months postindex date. Of the 8836 opioid initiators with cancer initially considered, approximately 9.3% (n = 821) had a diagnosis of constipation during follow-up. Opioid use patterns were compared between patients with constipation and matched controls. Two-part semilogarithmic regression models assessed the impact of constipation on resource utilization and associated costs. Compared with controls without constipation, patients with constipation had higher rates of concurrent use of>or =2 opioids (P<.0001), opioid discontinuation (P = .0002), opioid switching (P<.0001), nausea with vomiting (P<.0001), and respiratory depression (P = .0003). Compared with controls, more patients with constipation received inpatient (P<.0001), hospice (P = .0086), home health (P<.0001), laboratory (P = .0015), other outpatient (P<.0001), emergency (P<.0001), office visit (P<.0001), and nursing home care (P = .0266). Compared with controls, patients with constipation had substantially higher total costs (P<.0001). This study suggests that in opioid-treated cancer patients, constipation significantly impacts opioid-use patterns, resource utilization, and costs. Alleviation of constipation may optimize opioid therapy and reduce costs.
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RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC 27709, USA. scandrilli@rti.org
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