Presented at the 2012 AAPM Annual Meeting « Back

A Descriptive Study of the Direct Medical Costs of Opioid Management and the Functional Status of Subjects with Polytrauma History >2 Years and Chronic Noncancer Pain: Impact on Life Care Planning

Armando S. Miciano, MD, drmiciano@me.com, Nevada Rehabilitation Institute, Las Vegas, Nevada

The study calculated the direct medical costs of opioid management (DMC) of subjects with Polytrauma >2 years and determined the functional status due to pain-related impairment (PRI) using the Pain Disability Questionnaire (PDQ), from the AMA Guides to Evaluation of Permanent Impairment, 6th Edition. The retrospective study computed DMC from outpatient rehabilitation clinic records; average retail charges of opioids (internet-based) were calculated for a 12-month period on 37 subjects. PDQ measured the PRI. Subjects were stratified by the PDQ based on Functional Status (FS) and Psychosocial Status (PS). Yearly DMC ranged $623-$18,125 (mean $5875; SD $3742) and accounted for 41-62% of total medications costs (TMC), averaging 42% TMC. The opioid types were 0-4 (average two opioids/subject). PDQ scores ranged: PDQ-FS 23-90 of 90 (mean 59.7; SD 16); PDQ-PS 16-60 of 60 (mean 43; SD 11); and, PDQ-Total 24-150 of 150 (mean 99; SD 28). DMC moderately accounted for TMC. PRI were mostly in the moderate severity, the physical function low, and the psychosocial status poor. There was a trend relationship of DMC to PRI, physical function, and psychosocial status. The studied cost type only included a portion of TMC in managing polytrauma, i.e., not included pain specialist visits, psychotropics, rehabilitation, and cognitive-behavioral therapy. Nevertheless, it found the health and economic burden from opioid care related to polytrauma to be substantial. The study recommends that opioid management to be based on the individual’s FS. Further study on the correlation of DMC of opioids and PDQ-FS, PDQ-PS, & PDQ-Total should be done.

Funding: Nevada Rehabilitation Institute