Clinical characteristics, pharmacotherapy, and healthcare resource use among patients with diabetic neuropathy newly prescribed pregabalin or gabapentin

Mugdha Gore, Kei Sing Tai, Gergana Zlateva, Arthi Bala Chandran, Douglas Leslie

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective: To characterize comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with painful diabetic peripheral neuropathy (pDPN) newly prescribed pregabalin or gabapentin in clinical practice. Methods: Using the LifeLink Health Plan Claims Database, patients with pDPN (ICD-9-CM codes 357.2 or 250.6) newly prescribed (index event) gabapentin (n=1,178; 56.9±10.3years old) were identified and propensity score-matched with patients initiated on pregabalin (n=1,178; 56.4±9.8years old). Comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs were examined during the 12-month pre-index and follow-up periods. Results: Both cohorts were characterized by multiple comorbidities and substantial use of pain-related and adjunctive medications. In the pregabalin cohort, the use of tricyclic antidepressants significantly decreased (16.0% vs. 13.2%) and nonsteroidal anti-inflammatory drugs (30.8% vs. 34.8%), muscle relaxants (19.2% vs. 22.9%), anticonvulsants (14.4% vs. 18.1%), benzodiazepines (22.3% vs. 25.0%), and topical agents (7.0% vs. 9.8%) increased (P<0.05) in the follow-up period. In the gabapentin cohort, there were significant increases (P<0.05) in the use of short-acting (55.4% vs. 61.2%) and long-acting (9.4% to 12.8%) opioids, serotonin-norepinephrine re-uptake inhibitors (14.2% vs. 16.7%), anticonvulsants (7.1% vs. 19.2%), benzodiazepines (19.1% vs. 24.3%), sedative/hypnotics (14.9% vs. 18.0%), and tramadol (13.3% vs. 16.8%). There were significant increases (P<0.05) in pharmacy, outpatient, and total costs in both cohorts and in costs of physician office visits in the gabapentin cohort. There was no difference in postindex median total costs between the pregabalin and gabapentin cohorts ($16,137 vs. $15,766). Conclusions: Patients with pDPN prescribed pregabalin and gabapentin had a substantial comorbidity and pain medication burden. Although healthcare costs increased in both groups, the increase in pain medication burden was higher in the gabapentin group. Direct medical costs were similar for both groups. Given the human and economic burden of pDPN, future research may benefit from a focus on efficacy parameters to further differentiate treatment options.

Original languageEnglish (US)
Pages (from-to)528-539
Number of pages12
JournalPain Practice
Volume11
Issue number6
DOIs
StatePublished - Jan 1 2011

Fingerprint

Diabetic Neuropathies
Delivery of Health Care
Drug Therapy
Peripheral Nervous System Diseases
Comorbidity
Costs and Cost Analysis
Pain
Benzodiazepines
Anticonvulsants
Office Visits
Tramadol
Physicians' Offices
Propensity Score
Tricyclic Antidepressive Agents
International Classification of Diseases
gabapentin
Pregabalin
Hypnotics and Sedatives
Health Care Costs
Opioid Analgesics

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine

Cite this

@article{a25abf03be4745a2a689681eac25a5e7,
title = "Clinical characteristics, pharmacotherapy, and healthcare resource use among patients with diabetic neuropathy newly prescribed pregabalin or gabapentin",
abstract = "Objective: To characterize comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with painful diabetic peripheral neuropathy (pDPN) newly prescribed pregabalin or gabapentin in clinical practice. Methods: Using the LifeLink™ Health Plan Claims Database, patients with pDPN (ICD-9-CM codes 357.2 or 250.6) newly prescribed (index event) gabapentin (n=1,178; 56.9±10.3years old) were identified and propensity score-matched with patients initiated on pregabalin (n=1,178; 56.4±9.8years old). Comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs were examined during the 12-month pre-index and follow-up periods. Results: Both cohorts were characterized by multiple comorbidities and substantial use of pain-related and adjunctive medications. In the pregabalin cohort, the use of tricyclic antidepressants significantly decreased (16.0{\%} vs. 13.2{\%}) and nonsteroidal anti-inflammatory drugs (30.8{\%} vs. 34.8{\%}), muscle relaxants (19.2{\%} vs. 22.9{\%}), anticonvulsants (14.4{\%} vs. 18.1{\%}), benzodiazepines (22.3{\%} vs. 25.0{\%}), and topical agents (7.0{\%} vs. 9.8{\%}) increased (P<0.05) in the follow-up period. In the gabapentin cohort, there were significant increases (P<0.05) in the use of short-acting (55.4{\%} vs. 61.2{\%}) and long-acting (9.4{\%} to 12.8{\%}) opioids, serotonin-norepinephrine re-uptake inhibitors (14.2{\%} vs. 16.7{\%}), anticonvulsants (7.1{\%} vs. 19.2{\%}), benzodiazepines (19.1{\%} vs. 24.3{\%}), sedative/hypnotics (14.9{\%} vs. 18.0{\%}), and tramadol (13.3{\%} vs. 16.8{\%}). There were significant increases (P<0.05) in pharmacy, outpatient, and total costs in both cohorts and in costs of physician office visits in the gabapentin cohort. There was no difference in postindex median total costs between the pregabalin and gabapentin cohorts ($16,137 vs. $15,766). Conclusions: Patients with pDPN prescribed pregabalin and gabapentin had a substantial comorbidity and pain medication burden. Although healthcare costs increased in both groups, the increase in pain medication burden was higher in the gabapentin group. Direct medical costs were similar for both groups. Given the human and economic burden of pDPN, future research may benefit from a focus on efficacy parameters to further differentiate treatment options.",
author = "Mugdha Gore and Tai, {Kei Sing} and Gergana Zlateva and {Bala Chandran}, Arthi and Douglas Leslie",
year = "2011",
month = "1",
day = "1",
doi = "10.1111/j.1533-2500.2011.00450.x",
language = "English (US)",
volume = "11",
pages = "528--539",
journal = "Pain Practice",
issn = "1530-7085",
publisher = "Wiley-Blackwell",
number = "6",

}

Clinical characteristics, pharmacotherapy, and healthcare resource use among patients with diabetic neuropathy newly prescribed pregabalin or gabapentin. / Gore, Mugdha; Tai, Kei Sing; Zlateva, Gergana; Bala Chandran, Arthi; Leslie, Douglas.

In: Pain Practice, Vol. 11, No. 6, 01.01.2011, p. 528-539.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical characteristics, pharmacotherapy, and healthcare resource use among patients with diabetic neuropathy newly prescribed pregabalin or gabapentin

AU - Gore, Mugdha

AU - Tai, Kei Sing

AU - Zlateva, Gergana

AU - Bala Chandran, Arthi

AU - Leslie, Douglas

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Objective: To characterize comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with painful diabetic peripheral neuropathy (pDPN) newly prescribed pregabalin or gabapentin in clinical practice. Methods: Using the LifeLink™ Health Plan Claims Database, patients with pDPN (ICD-9-CM codes 357.2 or 250.6) newly prescribed (index event) gabapentin (n=1,178; 56.9±10.3years old) were identified and propensity score-matched with patients initiated on pregabalin (n=1,178; 56.4±9.8years old). Comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs were examined during the 12-month pre-index and follow-up periods. Results: Both cohorts were characterized by multiple comorbidities and substantial use of pain-related and adjunctive medications. In the pregabalin cohort, the use of tricyclic antidepressants significantly decreased (16.0% vs. 13.2%) and nonsteroidal anti-inflammatory drugs (30.8% vs. 34.8%), muscle relaxants (19.2% vs. 22.9%), anticonvulsants (14.4% vs. 18.1%), benzodiazepines (22.3% vs. 25.0%), and topical agents (7.0% vs. 9.8%) increased (P<0.05) in the follow-up period. In the gabapentin cohort, there were significant increases (P<0.05) in the use of short-acting (55.4% vs. 61.2%) and long-acting (9.4% to 12.8%) opioids, serotonin-norepinephrine re-uptake inhibitors (14.2% vs. 16.7%), anticonvulsants (7.1% vs. 19.2%), benzodiazepines (19.1% vs. 24.3%), sedative/hypnotics (14.9% vs. 18.0%), and tramadol (13.3% vs. 16.8%). There were significant increases (P<0.05) in pharmacy, outpatient, and total costs in both cohorts and in costs of physician office visits in the gabapentin cohort. There was no difference in postindex median total costs between the pregabalin and gabapentin cohorts ($16,137 vs. $15,766). Conclusions: Patients with pDPN prescribed pregabalin and gabapentin had a substantial comorbidity and pain medication burden. Although healthcare costs increased in both groups, the increase in pain medication burden was higher in the gabapentin group. Direct medical costs were similar for both groups. Given the human and economic burden of pDPN, future research may benefit from a focus on efficacy parameters to further differentiate treatment options.

AB - Objective: To characterize comorbidities, pain-related pharmacotherapy, and healthcare resource use among patients with painful diabetic peripheral neuropathy (pDPN) newly prescribed pregabalin or gabapentin in clinical practice. Methods: Using the LifeLink™ Health Plan Claims Database, patients with pDPN (ICD-9-CM codes 357.2 or 250.6) newly prescribed (index event) gabapentin (n=1,178; 56.9±10.3years old) were identified and propensity score-matched with patients initiated on pregabalin (n=1,178; 56.4±9.8years old). Comorbidities, pain-related pharmacotherapy, and healthcare resource use/costs were examined during the 12-month pre-index and follow-up periods. Results: Both cohorts were characterized by multiple comorbidities and substantial use of pain-related and adjunctive medications. In the pregabalin cohort, the use of tricyclic antidepressants significantly decreased (16.0% vs. 13.2%) and nonsteroidal anti-inflammatory drugs (30.8% vs. 34.8%), muscle relaxants (19.2% vs. 22.9%), anticonvulsants (14.4% vs. 18.1%), benzodiazepines (22.3% vs. 25.0%), and topical agents (7.0% vs. 9.8%) increased (P<0.05) in the follow-up period. In the gabapentin cohort, there were significant increases (P<0.05) in the use of short-acting (55.4% vs. 61.2%) and long-acting (9.4% to 12.8%) opioids, serotonin-norepinephrine re-uptake inhibitors (14.2% vs. 16.7%), anticonvulsants (7.1% vs. 19.2%), benzodiazepines (19.1% vs. 24.3%), sedative/hypnotics (14.9% vs. 18.0%), and tramadol (13.3% vs. 16.8%). There were significant increases (P<0.05) in pharmacy, outpatient, and total costs in both cohorts and in costs of physician office visits in the gabapentin cohort. There was no difference in postindex median total costs between the pregabalin and gabapentin cohorts ($16,137 vs. $15,766). Conclusions: Patients with pDPN prescribed pregabalin and gabapentin had a substantial comorbidity and pain medication burden. Although healthcare costs increased in both groups, the increase in pain medication burden was higher in the gabapentin group. Direct medical costs were similar for both groups. Given the human and economic burden of pDPN, future research may benefit from a focus on efficacy parameters to further differentiate treatment options.

UR - http://www.scopus.com/inward/record.url?scp=80655149578&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80655149578&partnerID=8YFLogxK

U2 - 10.1111/j.1533-2500.2011.00450.x

DO - 10.1111/j.1533-2500.2011.00450.x

M3 - Article

C2 - 21435162

AN - SCOPUS:80655149578

VL - 11

SP - 528

EP - 539

JO - Pain Practice

JF - Pain Practice

SN - 1530-7085

IS - 6

ER -