Breakthrough Pain and Cancer Costs

Orlando—A survey of a commercial health plan found that members with cancer and controlled, persistent pain had statistically significant higher mean unadjusted all-cause pharmacy costs if they had breakthrough pain compared with if they had no breakthrough pain. For cancer patients with breakthrough pain, total direct all-cause healthcare costs were most highly associated with prior surgeries, while all-cause pharmacy costs were most associated with the severity of comorbidities.

Results were presented at the AAPM meeting. The poster was titled Costs Associated with Breakthrough Pain in Cancer Patients.

The authors defined breakthrough pain as a transitory experience of severe or excruciating pain. According to previous surveys, cancer patients with breakthrough pain have more severe pain, less effective analgesic treatment, impaired functioning, mood disturbance, a perception of a loss of body control, and a relatively poorer quality of life.

In this study, the authors identified people with health insurance from the HealthCore Integrated research database, which includes information 6.4 million patients from 14 health plans who were at least 18 years of age and had been enrolled for at least 12 months. After reviewing International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and pharmacy prescription claims, they divided eligible patients into 4 groups. This sub-analysis examined patients with cancer and breakthrough pain and patients with cancer but no breakthrough pain.

Patients were included if they had a confirmed cancer diagnosis, an ICD-9-CM code for chronic pain, and controlled, persistent pain confirmed during a phone interview. They were excluded if they had an ICD-9-CM code or Healthcare Common Procedure Coding System code for drug abuse or dependence on methadone or if they had acute, intermittent, or inadequately controlled persistent pain.

Of the 145 patients with cancer pain, 77.2% had breakthrough pain. The mean age of patients was 57.7 years in the no breakthrough pain group and 53.6 years in the breakthrough pain group, while 78.8% and 74.1% of the patients in the groups, respectively, were female.

The mean annual all-cause pharmacy costs were $20,088 in the breakthrough pain group and $9939 in the no breakthrough pain group (P=.0076). The differences were not significant in the groups when measuring inpatient admissions, emergency department visits, outpatient services, physician office visits, total medical costs, or total direct all-cause costs.

For cancer patients with or without breakthrough pain, the authors also found that the Deyo-Charlson Comorbidity Index and a history of prior surgery were associated with significant increases in total direct all-cause healthcare costs (P<.0001). Increasing age also associated with a significant decrease in total direct all-cause healthcare costs for both groups (P=.0048).

Patients in the breakthrough pain had a 28.6% increase in total direct all-cause healthcare costs compared with the no breakthrough pain group, although the difference was not significant (P=.3211). All-cause pharmacy costs were 81.7% higher in the breakthrough pain group compared with the no breakthrough pain group (P=.0265). In both groups, the Deyo-Charlson Comorbidity Index was associated with a significant increase in all-cause pharmacy costs (P<.0001).

Further, in the breakthrough pain group, age, Deyo-Charlson Comorbidity Index, and history of prior surgery within 12 months were significantly associated with total direct all-cause healthcare costs, while Deyo-Charlson Comorbidity Index and moderate baseline pain severity were significantly associated with all-cause pharmacy costs.

This study was sponsored by Cephalon, Inc., a wholly owned subsidiary of Teva Pharmaceuticals Industries, Ltd.