QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Berger, A. Articles by Oster, G. Search for Related Content PubMed PubMed Citation Articles by Berger, A. Articles by Oster, G.

ANALGESIA

Therapy Switching in Patients Receiving Long-Acting Opioids

Senior Analyst, Policy Analysis Inc., Brookline, MA

Deborah L Hoffman, PhD

at time of writing, Assistant Director of Health Economics and Outcomes Research, Purdue Pharma, L.P., Stamford, CT; now, Independent Consultant, Hamden, CT

Seth Goodman

at time of writing, Computer Programmer, Policy Analysis Inc.; now, Programmer, PharMetrics Inc., Watertown, MA

Thomas E Delea, MBA

Senior Consultant, Policy Analysis Inc.

Raafat Seifeldin, PhD PharmD

Executive Director of World Wide Health Economics and Outcomes Research, Purdue Pharma, L.P.

Gerry Oster, PhD

Vice President, Policy Analysis Inc.

Reprints: Gerry Oster PhD, Policy Analysis, Inc., Four Davis Ct., Brookline, MA 02445-7629, fax 617/232-1155, goster{at}pai2.com

BACKGROUND: Patterns of therapy switching in patients receiving long-acting opioids have not been well documented.

OBJECTIVE: To compare therapy switching among patients beginning treatment with controlled-release (CR) oxycodone, transdermal fentanyl, or CR morphine sulfate.

METHODS: Using a US healthcare claims database, we identified patients beginning treatment with CR oxycodone, transdermal fentanyl, or CR morphine sulfate between July 1, 1998, and December 31, 1999. We compiled claims for each patient for 6 months following therapy initiation and compared the incidence of therapy switching among the 3 groups. We also estimated total healthcare charges for patients who switched therapy versus those who did not.

RESULTS: We identified 1931, 668, and 449 patients beginning therapy with CR oxycodone, transdermal fentanyl, and CR morphine sulfate, respectively; 16.7%, 25.0%, and 35.9%, respectively, had cancer. For patients without cancer, rates of therapy switching at 6 months were 10.6% (CR oxycodone), 19.0% (transdermal fentanyl), and 26.0% (CR morphine sulfate); for those with cancer, rates were 23.8%, 24.6%, and 29.8%, respectively. Multivariate hazard ratios (vs CR morphine sulfate) for therapy switching in patients without cancer were 0.36 (95% CI, 0.27 to 0.47) for CR oxycodone and 0.69 (0.51 to 0.94) for transdermal fentanyl; for those with cancer, corresponding hazard ratios were 0.72 (0.50 to 1.03) and 0.76 (0.50 to 1.16). Total healthcare charges were significantly (p < 0.01) higher for patients who switched therapy than those who did not ($23 965 vs $14 299 in pts. without cancer; $58 259 vs $39 618 for those with cancer).

CONCLUSIONS: Patients without cancer who receive CR oxycodone or transdermal fentanyl are less likely to switch therapy than those receiving CR morphine sulfate. Total healthcare charges are higher for patients who switch therapy.

Key Words: healthcare costs, opiod analgesics, pharmacotherapy

Published Online, January 12, 2004. www.theannals.com, DOI 10.1345/aph.1D109

This article has been cited by other articles:

				R. White Comment: therapy switching in patients receiving long-acting opioids Ann. Pharmacother., October 1, 2004; 38(10): 1752 - 1753. [Full Text] [PDF]

				G. Oster and A. Berger Ann. Pharmacother., October 1, 2004; 38(10): 1753 - 1753. [Full Text] [PDF]

				G. Oster, A. Berger, and R. Seifeldin AUTHORS' REPLY Ann. Pharmacother., July 1, 2004; 38(7): 1325 - 1325. [Full Text] [PDF]

				P. L Jaderholm Comment: therapy switching in patients receiving long-acting opioids Ann. Pharmacother., July 1, 2004; 38(7): 1324 - 1325. [Full Text] [PDF]