VOC Events Increase Opioid Prescribing in Sickle Cell Disease

The majority of patients with sickle cell disease (SCD) who experience vaso-occlusive crises (VOC) events have a noticeable increase in the number of opioid prescriptions they receive, according to a study in the Journal of Health Economics and Outcomes Research.

The study was a retrospective analysis of Texas Medicaid medical and prescription claims data, recorded between September 2011 and August 2016. Data were obtained from inpatient, outpatient, prescription, and eligibility data files. The index date was considered the date of the first SCD diagnosis. Patients were included in the analysis if they had ≥1 inpatient or ≥2 outpatient SCD diagnoses during the study duration and had been continuously enrolled during a 12-month period after the index date.

The identified cohort of patients had a mean age of 21.4 years. The primary outcome of the study was the number of opioid prescriptions. The primary independent variable for the analysis was the mean number of VOCs.

Approximately 58.7% of the 3368 patients included in this study received ≥1 opioid prescription. Overall, patients had a mean number of 4.2 opioid prescriptions. Around 35.9% had received between 1 and 5 opioid prescriptions during the study. There were ≥1 VOC events in 61.5% of the patients, with an average number of 2.9 VOC events.

Each VOC event was linked to an increase in the number of opioid prescriptions by 9.5% (incidence rate ratio, 1.095; 95% CI, 1.078–1.111; P ≤.0001).

Additional covariates associated with higher opioid use included age (≥13 vs 2–12 years), increase in the number of nonopioid pain medications, non-study SCD-related medications, and SCD-related complications.

Limitations of this study include its retrospective design and reliance on claims data as well as the lack of data on potential confounders, including fetal hemoglobin levels and VOC events that were treated at home.

The investigators of this study suggest clinicians “and payers should focus more on the prevention of pain crises, rather than restricting opioid prescribing, for better disease management of SCD.”

Reference

Kang HA, Barner JC, Richards KM, Bhor M, Paulose J, Kutlar A. Association between vaso-occlusive crises and opioid prescriptions among patients with sickle cell disease: A retrospective claims-based study. J Health Econ Outcomes Res. 2020;7(1):94-101.