Comparison of Resource Utilization by Patients Treated with Transdermal Fentanyl and Long‐Acting Oral Opioids for Nonmalignant Pain

Objective.  To quantify resource utilization and costs incurred for patients who received transdermal fentanyl as their first long‐acting analgesic for non‐malignant pain, and to compare these with utilization and costs for similar patients dispensed other long‐acting oral opioids. Design.  A retrospective matched cohort study using medical claims data from a large New England Insurer. Patients.  We identified 478 patients without cancer who received transdermal fentanyl during 1995‐1998. We selected patients who had no previous long‐acting opioid dispensings and were enrolled during the 180 days before and 30 days following the initial dispensing. We used propensity scores to identify a matched comparison group of 478 long‐acting oral opioid users. Results.  Transdermal fentanyl and matched long‐acting oral opioid users incurred identical median costs for outpatient medical services and prescriptions during 2 years of follow‐up. A larger proportion of transdermal fentanyl patients were still taking their initial opioid analgesic at the end of the 2‐year follow‐up than were patients initially taking other long‐acting opioids. Use of short‐acting opioids tapered off more slowly among transdermal fentanyl patients than among long‐acting opioid patients. In the first 6 months, the transdermal fentanyl patients had more hospital discharges than the long‐acting oral opioid patients, but this difference appeared to reflect preexisting conditions. Conclusions.  Users of fentanyl transdermal system and other long‐acting opioids experienced essentially identical evolution of health services utilization and costs over a 2‐year period. The choice of long‐acting opioid analgesia does not appear to be a determinant of future medical costs.