The Cost of Lost Productivity in an Opioid Utilizing Pain Sample

Michael A Fishman,1 Ajay B Antony,2 Corey W Hunter,3 Jason E Pope,4 Peter S Staats,5 Rahul Agarwal,6 Allison T Connolly,6 Nirav Dalal,6 Timothy R Deer7 1Center for Interventional Pain and Spine, Exton, PA, USA; 2The Orthopaedic Institute, Gainesville, FL, USA; 3Ainsworth Institute of Pain Management, New York, NY, USA; 4Evolve Restorative Center, Santa Rosa, CA, USA; 5Premier Pain Centers, Shrewsbury, NJ, USA; 6Abbott, Sylmar, CA, USA; 7The Spine and Nerve Center of the Virginias, Charleston, WV, USACorrespondence: Michael A FishmanCenter for Interventional Pain and Spine, 160 North Pointe Blvd Suite 208, Lancaster, PA, 17603, USATel +1 917-543-6588Email mafishman@gmail.comBackground and Aims: Chronic pain affects more adults in the United States than any other condition. Opioid medications are widely used in the treatment of chronic pain, but there remains considerable risk and cost associated with their use. This study aims to characterize the effects of opioid prescribing for chronic pain and similar pain conditions on lost productivity in the United States.Methods: This was a retrospective, longitudinal, observational study of chronic pain patients in 2011– 2014. We identified patients with a diagnosis of musculoskeletal pain receiving index prescription for opioids in administrative claims and studied disability absence in a linked health and productivity management database. Patients were grouped as de novo and continued use opioid users before index, and by opioid dose in the year after index. Days of disability were compared before and after index with bootstrapping. Effect of opioid dose group on disability was evaluated with negative binomial regression. Lost productivity cost was compared before and after index.Results: The cohort contained 16,273 de novo and 6604 continued use patients. On average, de novo patients used 24.8 days of disability after index, an increase of 18.3 more days compared to before (p < 0.001). Continued use patients used 30.7 days after index, 9 more days than before (p < 0.001). There was a dose–response relationship between dose group and days of disability in de novo patients (p < 0.001). The weighted-average cost per person of lost productivity was $4344 higher in the year after index compared to the year before.Conclusion: Opioid prescriptions for pain patients were associated with significant disability use and lost productivity costs. With the evolution of opioid-prescribing practices, CDC recommendations, and the HHS Pain Management Best Practices, there is opportunity to use alternative pain therapies without the risks of opioid-induced side effects to improve work productivity.Keywords: opioids, pain, disability, productivity