OBJECTIVES

Opioids are widely used in moderate-to-severe chronic pain non-responsive to standard analgesics, despite not being recommended for osteoarthritis (OA) by OARSI/ACR guidelines. Strong opioids utilization in non-cancer pain is controversial considering other analgesics. Opioid prescriptions have increased in Europe last decade, although remains lower than in USA. This work projected future utilization and costs of opioids in chronic OA pain patients (included refractory to standard-of-care), and all-causes, from the perspective of the National Health System (NHS) in Spain.

METHODS

An epidemiological modelling was designed and populated with published trends in opioids dispensing from years 2010-2018 using Spanish Medicinal Agency rates of opioid prescribing in 18+ years old, the OPIOIDS study to estimate chronic OA pain patients receiving opioids and the Drug-Catalogue for opioid drug costs. Using these inputs, a best-fitted trend analysis model was applied estimating the likely number of dispensed opioid prescriptions and costs in the period 2019-2027.

RESULTS

In 2010, an estimated 10.03 Defined-Daily-Dose/1000 inhabitans_day opioid prescriptions were dispensed in Spain for the equivalent of 185,754 chronic OA pain patients/day (64,178 OA pain refractory, 383,948 overall). Based on dispensing trends and OA prevalence, the projected number of dispensed opioid prescriptions is expected to increase to 43.67 DDD/1000 inhabitant_day by 2027 (more than fourfold) or the equivalent of 848,344 chronic OA pain patients/day (293,103 OA pain refractory, 1,753,501 overall); 38.8% on strong opioids. The estimated cost was €110.9 million in OA (€39.4M in OA refractory, €198.7M overall) in 2010 rising to, respectively €506.7 million (€180.0M refractory, €736.8M overall) by 2027.

CONCLUSIONS

Chronic OA-pain-related opioid dispensing and drug costs to the NHS are set to increase substantially (fourfold) from 2010 to 2027 in Spain. Continuing using opioids for OA pain is concerning given joint disease chronicity and other related cost (opioid-related-harms and out-of-pocket costs) not computed in these projections.