Journal de la douleur et du soulagement

Abstrait

Healthcare Resource Utilization And Costs Of Spinal Cord Injury With Neuropathic Pain In A Medicare Population

Margolis JM, Juneau P, Sadosky A, Cappelleri JC, Bryce TN and Nieshoff EC

Objective: Evaluation of healthcare resource utilization (HRU) and costs in patients with neuropathic pain (NeP) secondary to spinal cord injury (SCI) in a Medicare population.

Methods: Using data from the MarketScan Medicare Database between January 1, 2006 and June 30, 2011, patients with NeP following SCI (SCI-NeP cohort) were identified based on an ICD-9-CM diagnostic code indicative of SCI, and NeP (index event) within 12 months based on ICD-9-CM code 338.0x (central neuropathic pain) or a claim for an NeP-related antiepileptic or NeP-related antidepressant drug, and propensity score-matched to SCI patients without NeP (SCI-only). Pre-index demographic and clinical characteristics were compared between the cohorts. HRU and expenditures were compared for 12 months post-index. Generalized linear models and ordinary least squares models evaluated the association between characteristics and outcomes.

Results: The matched cohorts included 1,418 patients (approximately 54% male, mean age 77 years). During the 12-month follow-up period, SCI-NeP patients showed significantly greater use of evaluated medications (P < 0.01), and significantly higher HRU (P < 0.05), including 20% and 18% increased odds of hospitalization and emergency department visits, respectively. Mean (SD) total all-cause healthcare expenditures for this period adjusted for covariates showed an annual incremental economic burden of $6,808 (95% confidence interval $4,143, $9,764) per patient with NeP.

Conclusions: Medicare patients with NeP secondary to SCI have significantly higher HRU and costs relative to SCI patients without NeP. Medicare patients represent a population with special needs regarding therapeutic choices that may benefit from an integrated approach to NeP management.