Ancillary analysis of the
OPIOIDS real-world, non-interventional, retrospective, 4-year longitudinal study including patients aged at least 18 years with moderate-to-severe chronic OA
pain refractory to standard-of-care with sequential
NSAIDs plus
opioids. Burden assessment included measurement of
analgesia, cognitive functioning, basic
activities of daily living, severity and frequency of comorbidities, and all-cause mortality. Costs accounted for healthcare resource utilization and related costs (year 2018).
RESULTS: Records of 13,317 patients were analyzed; 68.9 (14.7) years old, 71.3% (70.5-72.1%) women, 58.1% refractory to
NSAID plus weak
opioid and 41.9% to
NSAID plus strong
opioid, accounting for 10.7% (10.5-10.8%) of patients with chronic OA
pain. Mean number of comorbidities was 2.9 (1.8) and its severity was 1.8 (1.7).
Pain decreased by 0.9 points (12.2%) and cognitive declined by 2.3 points (9.1%, with 4.3% more patients with cognitive deficit) and dependency worsened by 0.4 points (0.5%, with 2.3% more patients with severe-to-total dependence) over a mean treatment period of 188.6 (185.4-191.8) days on
NSAIDs followed by 400.6 (393.7-407.5) days on
opioids. The adjusted mortality rate was higher in patients with OA taking
NSAID plus strong
opioids; hazard ratio 1.44 (1.26-1.65; p < 0.001). The 4-year healthcare cost was €7350/patient (€7193-7507 or €1838/year) and was higher in those taking strong versus weak
opioids; €9886 (€9608-10,164, €2472/year) vs. €5519 (€5349-5689, €1380/year), p < 0.001.
Analgesia cost (16.0% of total cost, 70.2%
opioids) was higher with strong versus weak
opioids, 19.6% vs. 11.3%, p < 0.001.
CONCLUSIONS: In routine clinical practice in Spain, patients with moderate-to-severe chronic OA
pain refractory to standard
analgesic treatment with
NSAIDs plus
opioids reported modest reductions in
pain, while presenting a considerable burden of comorbidities,
cognitive impairment, and dependency. Healthcare costs significantly increased for the NHS particularly with
NSAIDs plus strong
opioids.