Health economic impact of moderate-to-severe chronic pain associated with osteoarthritis in England: a retrospective analysis of linked primary and secondary care data.

Despite the prevalence of osteoarthritis (OA) in England, few studies have examined the health economic impact of chronic pain associated with OA. The aim of this study was to compare outcomes in patients with moderate-to-severe chronic pain associated with OA and matched controls without known OA. Retrospective, longitudinal, observational cohort study. Electronic records extracted from the Clinical Practice Research Datalink GOLD primary care database linked to Hospital Episode Statistics (HES) data set. Patients (cases; n=5931) ≥18 years and with existing diagnosis of OA and moderate-to-severe pain associated with their OA, and controls matched on age, sex, comorbidity burden, general practitioner (GP) practice and availability of HES data. None. Total healthcare resource use (HCRU) and direct healthcare costs during 0-6, 0-12, 0-24 and 0-36 months of follow-up. Secondary outcomes measures included pharmacological management and time to total joint replacement. Patients with moderate-to-severe chronic pain associated with OA used significantly more healthcare services versus matched controls, reflected by higher HCRU and significantly higher direct costs. During the first 12 months' follow-up, cases had significantly more GP consultations, outpatient attendances, emergency department visits and inpatient stays than matched controls (all p<0.0001). Total mean costs incurred by cases during 0-12 months' follow-up were five times higher in cases versus controls (mean (SD): £4199 (£3966) vs £781 (£2073), respectively). Extensive cycling through pharmacological therapies was observed; among cases, 2040 (34.4%), 1340 (22.6%), 841 (14.2%), 459 (7.7%) and 706 (11.9%) received 1-5, 6-10, 11-15, 16-20 and >20 lines of therapy, respectively. This wide-ranging, longitudinal, observational study of real-world primary and secondary care data demonstrates the impact of moderate-to-severe chronic pain associated with OA in patients compared with matched controls. Further studies are required to fully quantify the health economic burden of moderate-to-severe pain associated with OA.

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Déclaration de conflit d'intérêts

Competing interests: GC and PC are employees of Pfizer UK, which provided funding for this study. CL was an employee of Pfizer UK at the time of the work and is now employed by Pfizer Australia. HS was an employee of Pfizer UK during the conduct of the work. RW and TT are employees of Adelphi Real World, which received funding to conduct this study. RK declares a personal financial interest in his employment by the University of Nottingham, which receives funding for his salary in part from the Primary Integrated Community Solutions. In the past 36 months, RK declares consultancy through his employment with the University of Nottingham to Pfizer and Mibe. AJD declares a personal financial interest in his employment with York Medical Group (YMG), and over the past 36 months with NHS111 and RCP (London), from whom he receives payment for his work as a part-time salaried general practitioner (GP) with YMG, and over the past 36 months as a GP on the NHS111 COVID-19 Response and the NICE Gout Committee, respectively, and in his ownership and directorship of AD Outcomes. In the past 36 months, AJD declares the following personal financial interests through medical and health economics consultancy work for AD Outcomes for: Emotive (Agency), Grunenthal (UK), Grunenthal (GmbH), Pfizer (UK), Pharmacy Magazine, Spink Health, Tilray (Portugal) and RCGP, as a racecourse doctor for various racecourses (Croft, Doncaster, Market Rasen, Newcastle, Pontefract, Redcar, Southwell and Thirsk) and as a locum GP with out-of-hours, NHS111 and urgent care work for Vocare part of Totally. AJD has a non-personal financial interest in his roles as a Trustee of the Primary Care Rheumatology & Musculoskeletal Medicine (PCRMM) Society (Trustee from 2017 to 2020) and as Trustee of the UK Gout Society (ongoing). The PCRMM Society has received funding from multiple companies for its annual conference including from Pfizer (UK) in 2020. AJD’s work as a Trustee of PCRMM Society and UK Gout Society and as GP Clinical Lead for the North of England Low Back Pain Group are voluntary and unpaid. DW declares a personal financial interest in his employment by the University of Nottingham, which receives funding for his salary from the UK Government, Sherwood Forest Hospitals NHS Foundation Trust and UKRI. He is Director UKRI/Versus Arthritis Advanced Pain Discovery Platform (personal pecuniary: paid by University of Nottingham as part of job plan, funded by UKRI), Honorary Consultant Rheumatologist at Sherwood Forest Hospitals NHS Foundation Trust (personal pecuniary; paid by University of Nottingham as part of job plan, funded by Sherwood Forest Hospitals) and Professor of Rheumatology, University of Nottingham (personal pecuniary; paid by University of Nottingham). In the past 36 months DW declares the following non-personal financial interests: research support to the University of Nottingham from Versus Arthritis and National Institute for Health and care Research; grants from Pfizer, Eli Lilly, and UCB Pharma; consultancy through his employment with the University of Nottingham to Pfizer, Eli Lilly, AbbVie, AKL R&D, Galapagos, Reckitt Benckiser Health, and GlaxoSmithKline, and responsibilities for investigator-led grants outside the work in this presentation held by the University of Nottingham from Pfizer, Lilly and UCB Pharma, and research grants from Versus Arthritis; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events (to University of Nottingham) from Pfizer and AbbVie.