PMID- 22686662
OWN - NLM
STAT- MEDLINE
DCOM- 20120924
LR  - 20221207
IS  - 1179-2027 (Electronic)
IS  - 1170-7690 (Linking)
VI  - 30
IP  - 7
DP  - 2012 Jul 1
TI  - Duloxetine use in chronic low back pain: treatment patterns and costs.
PG  - 595-609
LID - 10.2165/11598130-000000000-00000 [doi]
AB  - BACKGROUND: Little is known about the real-world treatment patterns and costs of 
      patients with chronic low back pain (CLBP) who are treated with duloxetine 
      compared with those receiving other non-surgical treatments. OBJECTIVE: Our 
      objective was to compare the real-world treatment patterns and costs between 
      patients with CLBP who initiated duloxetine and matched controls who initiated 
      another non-surgical treatment. METHODS: The study sample was selected from a US 
      privately insured claims database (2004-8). Selected patients were aged 18-64 
      years, and had a low back pain (LBP) diagnosis (per Healthcare Effectiveness Data 
      and Information Set [HEDIS] specifications) with a subsequent CLBP-qualifying 
      diagnosis recorded >/=90 days after the initial LBP diagnosis. Duloxetine-treated 
      patients had >/=1 duloxetine prescription within 6 months after CLBP diagnosis, no 
      prior duloxetine claim, and continuous eligibility >/=12 months before first LBP 
      diagnosis and >/=6 months after index duloxetine prescription (study period). 
      Because duloxetine patients had higher rates of co-morbidities, 553 
      duloxetine-treated patients were matched to 553 control patients who initiated 
      another non-surgical LBP treatment based on propensity score and time from first 
      LBP diagnosis to treatment initiation. A subset (n = 103 each) of matched 
      employees with disability data was also analysed to assess work loss. Main 
      outcomes measures included study period treatment rates and direct (medical and 
      drug) costs from a third-party payer perspective and employee indirect 
      (work-loss) costs. McNemar tests were used to compare LBP treatment rates. 
      Bias-corrected bootstrapping t-tests were used to compare costs. RESULTS: After 
      matching, the two groups had balanced baseline characteristics including 
      demographics, LBP diagnostic categories, co-morbidity profiles, resource use, 
      treatment patterns and mean direct costs. During the 6-month study period, 
      matched duloxetine-treated patients had significantly lower rates of other 
      pharmacological therapy (e.g. 56.2% vs 64.9% narcotic opioids, p = 0.0024; 34.9% 
      vs 49.5% NSAIDs, p < 0.0001) and non-invasive therapy (28.8% vs 38.5% 
      chiropractic therapy, p = 0.0007; 25.5% vs 35.4% physical therapy, p = 0.0004; 
      17.5% vs 28.4% exercise therapy, p < 0.0001) than controls. Duloxetine-treated 
      patients versus controls had similar back surgery rates (2.2% vs 3.8%; 
      p = 0.1127) and similar direct costs ($US7658 vs $US7439; p = 0.8119). Among CLBP 
      employees, duloxetine-treated employees versus controls had lower rates of other 
      non-surgical therapy, similar back surgery rates (0.0% vs 3.9%; p = 0.1250), 
      lower total direct and indirect costs ($US5227 vs $US7299; p = 0.0418), and 
      similar indirect costs ($US1806 vs $US2664; p = 0.0528). CONCLUSIONS: Duloxetine 
      treatment in CLBP patients/employees versus other non-surgical treatment was 
      associated with reduced rates of non-surgical therapies and similar back surgery 
      rates, without increased costs.
FAU - Ivanova, Jasmina I
AU  - Ivanova JI
AD  - Analysis Group, Inc., New York, NY 10020, USA. jivanova@analysisgroup.com
FAU - Birnbaum, Howard G
AU  - Birnbaum HG
FAU - Kantor, Evan
AU  - Kantor E
FAU - Schiller, Matt
AU  - Schiller M
FAU - Swindle, Ralph W
AU  - Swindle RW
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - New Zealand
TA  - Pharmacoeconomics
JT  - PharmacoEconomics
JID - 9212404
RN  - 0 (Serotonin Uptake Inhibitors)
RN  - 0 (Thiophenes)
RN  - 9044SC542W (Duloxetine Hydrochloride)
MH  - Adult
MH  - Comorbidity
MH  - Costs and Cost Analysis
MH  - Duloxetine Hydrochloride
MH  - Female
MH  - Humans
MH  - Insurance, Health/economics
MH  - International Classification of Diseases
MH  - Low Back Pain/*drug therapy/*economics/surgery
MH  - Male
MH  - Middle Aged
MH  - Orthopedic Procedures/economics
MH  - Selective Serotonin Reuptake Inhibitors/*economics/*therapeutic use
MH  - Sick Leave/economics
MH  - Thiophenes/*economics/*therapeutic use
EDAT- 2012/06/13 06:00
MHDA- 2012/09/25 06:00
CRDT- 2012/06/13 06:00
PHST- 2012/06/13 06:00 [entrez]
PHST- 2012/06/13 06:00 [pubmed]
PHST- 2012/09/25 06:00 [medline]
AID - 2 [pii]
AID - 10.2165/11598130-000000000-00000 [doi]
PST - ppublish
SO  - Pharmacoeconomics. 2012 Jul 1;30(7):595-609. doi: 
      10.2165/11598130-000000000-00000.