Abstract: SA-PO902
Opioid Utilization for Pain Management Among Medicare Fee-for-Service Beneficiaries with ESRD in 2016
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1300 Health Maintenance, Nutrition, and Metabolism
Authors
- Maciejewski, Matthew L., VA HSR&D, Durham, North Carolina, United States
- Zepel, Lindsay, Duke University, Durham, North Carolina, United States
- Wang, Virginia, Durham VA Health Care System, Duke University, Durham, North Carolina, United States
- Diamantidis, Clarissa Jonas, Duke University School of Medicine, Durham, North Carolina, United States
- Olin, Serene, NCQA, Washington, District of Columbia, United States
- Blaz, Jacquelyn, National Committee for Quality Assurance, Washington, District of Columbia, United States
- Wilson-Frederick, Shondelle, CMS, Baltimore, Maryland, United States
- Smith, Valerie A., Duke University, Durham, North Carolina, United States
Background
Opioid misuse has raised concerns about opioid utilization under the Part D drug prescription benefit for Medicare beneficiaries. It is important to understand whether Medicare Fee-for-Service (FFS) beneficiaries with end-stage renal disease (ESRD) are more likely to utilize opioids compared to other beneficiaries.
Methods
We assembled a 100% Medicare FFS sample (n=20,880,490) with 12-month Part A, B, and D coverage between 1/1/2016-12/31/2016 to examine patient factors associated with 2 opioid utilization outcomes. We used a two-part model to estimate the probability of opioid utilization in 2016 via logistic regression and the level of average daily dose (ADD)≥120 morphine milligram equivalents (MME) via a generalized linear model with a gamma distribution and identity link in those with >1 opioid prescription. Beneficiary characteristics (age, disability, ESRD, dual eligibility, race and ethnicity, rurality, 16 chronic conditions) were adjusted.
Results
35% of FFS beneficiaries had 1 or more opioid prescription fills in 2016 and 1.5% had ADDs≥120 MME. Compared to age-eligible beneficiaries without ESRD, beneficiaries were more likely to fill opioids if they were disabled with ESRD (odds ratio (OR)=2.57, 95% confidence interval (CI): 2.53, 2.61) or without ESRD (OR=1.43, 95% CI: 1.42, 1.43), age eligible with ESRD (OR=1.99, 95% CI: 1.96, 2.02), or eligible due to ESRD alone (OR=2.31, 95% CI: 2.25, 2.37). Beneficiaries who were disabled without ESRD (OR=2.99, 95% CI: 2.95, 3.03) or with ESRD (OR=1.34, 95% CI: 1.29, 1.40) had higher odds of having ADDs≥120 MME, while beneficiaries who were age-eligible with ESRD (OR=0.71, 95% CI: 0.66, 0.76) had lower odds compared to those age-eligible without ESRD.
Conclusion
Beneficiaries who are vulnerable due to ESRD filled opioid prescriptions at higher rates than other beneficiaries and at ADDs ≥120 MME. Based on recently endorsed opioid-related quality metrics and more restricted policies on opioid dispensing, these beneficiaries should be prioritized for opioid optimization strategies to balance pain management and adverse event risk.
Funding
- Veterans Affairs Support