OBJECTIVES: Describe healthcare resource use and treatment patterns in Swedish patients with osteoarthritis (OA), including those identified as difficult-to-treat.

METHODS: In the ‘BISCUITS’ multi-registry, observational, cohort study, patients with an OA diagnosis were identified in Swedish speciality or primary care from 2011-2013 and followed for four years (excluding those with OA or cancer diagnoses in the three-year pre-index period). Cohort 1 was identified from national in- and outpatient care data. Cohort 2 had additional primary care data from Västergötland and Skåne. Annual all-cause inpatient/outpatient visits and OA-related surgeries were summarised. Dispensed nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids were summarised per year by Anatomic Therapeutic Chemical codes from the national register. Difficult-to-treat subgroups were: 1) ≥2 chronic comorbidities in the pre-index period; 2) top 10% of healthcare resource users, one-year post-index; 3) three types of pain medication prescriptions during pre-index to first year post-index, with ≥30 days between types; 4) NSAID contraindications.

RESULTS: Proportions of difficult-to-treat patients (subgroups 1─4) were somewhat similar in cohorts 1 (14/12/38/3% of 151,392) and 2 (13/9/24/3% of 76,249). Over a quarter of contraindicated patients received an NSAID prescription in the year of OA diagnosis. Overall, 21% of cohort 1 and 10% of cohort 2 had surgery post-index. Each year, surgical (vs. non-surgical) patients were more likely to use pain medications. Among non-surgical patients, opioid prescriptions and healthcare visits were more common each year in the difficult-to-treat subgroups vs the overall cohorts; furthermore, the proportion of non-surgical patients receiving an NSAID or opioid prescription generally declined, and the average annual defined daily dose per patient generally increased after OA diagnosis.

CONCLUSIONS: Oral NSAID and opioid use is common in Swedish patients with OA, and more so in difficult-to-treat subsets. This indicates a widespread unmet need for pain relief in these patients, particularly those with NSAID contraindications.