New pathways of care are needed to improve health care spending.
Patients living with psoriatic arthritis (PsA) or ankylosing spondylitis (AS) who use opioids have a higher rate of health care utilization and higher associated costs, according to research results presented at ACR Convergence 2022, which was held from November 10 to 14 in Philadelphia, Pennsylvania.1
Opioid use in individuals with spondyloarthritis is common; reports indicate a rate of opioid use between 20% and 30% in some patient cohorts. However, data on health care utilization in these patients are lacking. Therefore, investigators conducted a retrospective cohort study of adult patients with PsA or AS enrolled in FORWARD, the National Databank for Rheumatic Diseases. Patients who completed 1 or more Health Assessment Questionnaire-Disability Index and/or Bath Ankylosing Spondylitis Disease Activity Index between 2010 and 2019 were included in the study.
The cohort included a total of 828 patients with PsA and 334 patients with AS, of whom 21.3% (n = 177) and 27.4% (n = 91) used opioids. These patients had more comorbidities, a higher prevalence of smoking, and worse disease activity, as measured via questionnaire. These patients also tended to have higher use of any antirheumatic drug class. Those who used opioids were more likely to have higher rates of health care utilization and higher medical costs, inclusive of medical visits, diagnostic tests, direct medical costs, and pharmacy costs such as biologics or other drugs.
After adjusting for age, sex, and hospitalizations, patients with PsA who used opioids had 33% more medical visits on an annual basis compared with those not using opioids; results were similar in the AS cohort, with a 32% increase in annual medical visits. The annual number of diagnostic tests were “similarly elevated” for those who used opioids (56% and 68% in the PsA and AS groups, respectively). Those who used opioids also spent more on medical visits on an annual basis ($3464.70 USD and $4576.20 USD). These patients also spent more on medications such as biologics, conventional synthetic disease-modifying antirheumatic drugs, and other drug-related costs.
“New care pathways for these patients are needed to improve care and reduce costs,” the investigators concluded.
1. Ogdie A, Pedro S, Liew J, Michaud K. Opioid use and healthcare utilization in adults with PsA and AS. Presented at: American College of Rheumatology Convergence 2022; November 10-14, 2022; Philadelphia, PA. Abstract 0402.