OBJECTIVES: Opioid users are at higher risk for hospitalization, and evidence suggests that opioids are not superior to nonopioids for improving pain-related function. The primary objective compared healthcare expenditures and health-related quality of life (HRQoL) among patients using opioids alone, opioid combinations, and nonsteroidal anti-inflammatory drugs (NSAIDs) alone. The secondary objective involved identifying additional characteristics that differed significantly across groups.

METHODS: This was a retrospective cohort study using longitudinal, medical conditions and prescribed medicines files from 2016 – 2017 Medical Expenditure Panel Survey (MEPS). It included participants age ≥18 years with an ICD-10 code for musculoskeletal pain. Participants with no record of opioid or NSAID use were excluded. HRQoL was determined by Mental Component Score (MCS) and Physical Component Score (PCS) using SF-12V2. The data was analyzed using a generalized linear model with log-link, ANOVA, and chi-square tests with α=0.05, and was adjusted for the complex survey design of MEPS.

RESULTS: There were 2,267 total sample participants which consisted of 12% opioid only users (n=274), 37% NSAID only users (n=839), and 51% opioid combination users (n=1,154). Age, race, smoking status, 2017-family income, and having a provider differed significantly by group. Adjusting for demographics and health status, mean total expenditure differed significantly across all 3 groups: opioid only [$15,104 (±$9,336)]; NSAIDs [$6,834 (±$4,229)]; opioid combination [$12,984 (±$7,991)]. Mean total prescription expenditures differed significantly across all groups: opioid only [$4,326 (±$4,472)], NSAIDs [$2,267 (±$2,605)], and opioid combination [$3,193 (±$3,348)]. Mean MCS scores differed significantly across groups: opioid only [49 (±12)]; NSAIDs [51 (±10)]; opioid combination [49 (±11)]. Mean PCS score differed significantly across groups: opioid only [41 (±13)]; NSAIDs [46 (±11)]; opioid combination [43 (±12)].

CONCLUSIONS: Patients with musculoskeletal pain on opioids alone and in combination had higher healthcare expenditures, but significantly worse mental and physical health status compared to NSAID only users.