Costs of constipation due to opioid analgesics in England

Abstract

Constipation due to use of opioid analgesics is common in England, and poor control of opioid-induced constipation (OIC) may increase healthcare costs, according to findings of a Shionogi-funded study published in Clinical Therapeutics. Data from Clinical Practice Research Datalink, a UK primary care database, were used to investigate healthcare costs of OIC (requiring two or more laxative prescriptions) in patients prescribed strong opioids in 2016 who were previously laxative-näıve. Patients were classified as OIC unstable if the initially prescribed laxative required switching, augmentation or increased dosage, OIC stable if no change in the initial laxative was required, and non-OIC if they received no laxative or one prophylactically prescribed laxative only. Overall, 5916 (21.4%) out of 27 629 opioid episodes identified involved strong opioids in previously laxative-näıve patients; 2886 of these patients had OIC and 67.4% of these patients were classified as OIC unstable. Of the 1945 episodes of unstable OIC, 43.7%, 18.5% and 37.8% required one, two or at least three changes of laxative, respectively. Healthcare costs per patient per year were higher in patients with OIC versus without OIC (£4786* vs £3822). The adjusted cost ratio compared with patients without OIC was 1.14 (95% CI 1.09, 1.32) in those with stable OIC and 1.19 (95% CI; 1.09, 1.32) in those with three or more changes of laxative. It is important that OIC is recognized as a common adverse event of opioid therapy and that, in addition to the impact on the individual, OIC has health care cost implications. The consequences of OIC should be considered when initiating opioid therapy and effective strategies for recognizing and managing the condition implemented, said the authors.