Initiation of Transdermal Fentanyl Among US Commercially Insured Patients Between 2007 and 2015
- 1 October 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in Pain Medicine
- Vol. 21 (10), 2229-2236
- https://doi.org/10.1093/pm/pnaa091
Abstract
Introduction. This study examined patterns of initial transdermal fentanyl (TDF) claims among US commercially insured patients and explored the risk of 30-day hospitalization among patients with and without prior opioid exposure necessary to produce tolerance. Design. A retrospective cohort study of initial outpatient TDF prescriptions. Setting. A 10% random sample of commercially insured enrollees within the IQVIA Health Plan Claims Database (formerly known as PharMetrics Plus). Subjects. Individuals with a claim for TDF between 2007 and 2015. Methods. The primary exposure was a new transdermal fentanyl claim, and the primary outcome was guideline concordance based on time and dose exposure. Results. Among the 24,770 patients in the cohort, 4,848 (20%) patients had sufficient time exposure to opioids before TDF. Among those with sufficient time exposure, 3,971 (82%) had adequate opioid exposure based on the US Food and Drug Administration (FDA) package insert dosing guidance. Overall, 3,971 of the 24,770 (16%) patients received guideline-consistent TDF. An exploratory analysis of 30-day hospitalization after a TDF claim did not detect a difference in odds between guideline-consistent or -inconsistent groups when adjusted for variables known to influence the risk of opioid-induced respiratory depression. Conclusions. A majority of patients met FDA opioid dose thresholds for TDF but had insufficient time exposure based on package insert recommendations for tolerance. Exploratory analysis did not detect a difference in odds for all-cause hospitalization or respiratory-related 30-day hospitalization between guideline-consistent or -inconsistent TDF claims. Prescribers should continue to adhere to FDA TDF labeling, although certain aspects of the labeling should be reevaluated or clarified.Funding Information
- PhRMA Foundation
- Novartis Pharmaceuticals
- Takeda Pharmaceuticals
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