Long-term use of prescription opioids for non-cancer pain and mortality: a population-based, propensity-weighted cohort study.

OBJECTIVE: The objective of this study was to identify factors associated with long-term opioid use and to assess the association between long-term use and death. STUDY DESIGN: Retrospective cohort study combining several population-wide databases and covering a population of five million inhabitants, including all adults who were initiated on opioid treatment from 2014 to 2018 for non-cancer pain. METHODS: We used logistic regression models to identify factors associated with chronic opioid use and carried out survival analyses using multivariable Cox regression modelling for all-cause mortality during follow-up using inverse probability of treatment weighting (IPTW) and propensity scores based on the probability of using opioids chronically. RESULTS: Among 760,006 patients, 82,423 (10.85%) used opioids for 90 days or more after initiation. Initial therapy characteristics associated with higher risk for long-term use were initiating with long- and short-acting opioids (when compared to tramadol, odds ratio [OR]: 2.63, 95% confidence interval [CI]: 2.57, 2.69 and OR: 1.60, 95%CI: 1.46, 1.76, respectively), using higher daily doses (when compared to 50 morphine milligramme equivalent [MME] or less, prescribing 50 to 89 daily MME, OR: 1.76, 95%CI: 1.65, 1.87; 90 to 119 daily MME, OR: 2.44, 95%CI: 1.99, 3.01; and more than 120 daily MME, OR: 1.77, 95%CI: 1.64, 1.91), and overlapping with gabapentinoids (OR: 2.26, 95%CI: 2.20, 2.32), benzodiazepines (OR: 1.32, 95%CI: 1.30, 1.35), and antipsychotics (OR: 1.21, 95%CI: 1.16, 1.26). After IPTW, chronic opioid use was associated with higher risk of all-cause mortality when compared to short-term use (Hazard Ratio (HR): 1.37, 95%CI: 1.32, 1.42). Sensitivity analyses provided similar results. CONCLUSION: These findings may help healthcare managers to identify and address patients at higher risk of long-term use and riskier prescription patterns.

El papel de los sistemas de clasificación de pacientes en la financiación de las urgencias hospitalarias / The role of patient classification systems in the financing of hospital emergencies

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Los estudios del coste del alcoholismo: marco conceptual, limitaciones y resultados en España / Cost of illness studies: conceptual framework, limits and results in Spain

Los estudios sobre las consecuencias económicas del alcoholismo utilizan usualmente la metodología de “estudio del coste de la enfermedad”, donde el impacto de un determinado problema de salud sobre el bienestar de la sociedad se valora mediante la cuantificación de los costes de los recursos empleados para su prevención y tratamiento, los costes legales atribuibles, las pérdidas de productividad derivadas de la morbilidad y mortalidad específicas y la pérdida de años de vida ajustados por calidad. En España, y siguiendo esta metodología, se han valorado los costes del alcoholismo en más de 630.000 millones de pesetas anuales. Estos estudios han recibido críticas en relación con la identificación, medida y cuantificación de los costes, y su utilidad es discutida. Sin embargo, y pese a determinadas limitaciones, los estudios del coste de la enfermedad aproximan a la magnitud del problema, contribuyen a identificar los aspectos del problema que suponen un coste más elevado y, ayudan a orientar las políticas. El ajuste a las guías metodológicas y la explicitación detallada de las fuentes y métodos utilizados es un requisito necesario para su credibilidad (AU)

Studies on economic consequences of alcoholism usually use “cost-of-illness studies” methodology, where impact on society’s well-being of a certain problem of health is valued by means of quantifying the costs of resources used for its prevention and treatment, the attributable legal costs, the productivity losses derived from specific morbidity and mortality and the loss of quality adjusted life years. In Spain, and following this methodology, costs of alcoholism have been valued in more than 630,000 annual million pesetas. These studies have received critics in relation to the identification, measurement and quantification of costs, and their utility is been discussed. Nevertheless, and in spite of certain limitations, cost-of-illness studies approximate to the magnitude of the problem, contribute to identify aspects of the problem that suppose a higher cost and help to orient policies. Adjustment to methodology guides and explicit sources and used methods are necessary requirements for its credibility (AU)

[Drug expenditure in primary care: associated variables and allocation of drug budgets according to health district]. / Gasto farmacéutico en atención primaria: variables asociadas y asignación de presupuestos de farmacia por zonas de salud.

OBJECTIVES: Identify factors explaining variability in prescribing costs after reviewing ecological data related to costs and socio-demographic characteristics of the health care zones in the autonomous region of Valencia, and explore the usefulness of using the model to set prescribing budgets in basic healthcare zones. MATERIALS AND METHODS: An ecological analysis of the value socio-demographic characteristics and use of healthcare services to explain prescribing costs in 1997. Development of a prediction model based on multiple linear regression in data for prescribing costs in 1997 and validation in data for 1998. RESULTS: Factors that correlated positively with prescribing costs were the percentage of inhabitants over the age of 80, the death rate, the percentage of inhabitants with only primary education or less, the percentage of inhabitants between the ages of 65 and 79 and the distance from the capital city. A multivariate model including the death rate, the percentage of inhabitants 80 years of age and older, the number of cars per 100 inhabitants and number of visits per inhabitant accounted for 44.5% of the variations in prescribing costs in 1997 and 32% in 1998. CONCLUSIONS: Socio-demographic factors and certain variables associated with health care utilization can be applied, within certain limitations, to set prescribing budgets in basic healthcare zones.