F Hoffmann1, G Glaeske, R Windt. 1. Zentrum für Sozialpolitik (ZeS), Abteilung Gesundheitsökonomie, Gesundheitspolitik und Versorgungsforschung, Universität Bremen, Postfach 330440, 28334, Bremen, Deutschland. hoffmann@zes.uni-bremen.de
Abstract
BACKGROUND: The aim of this study was to analyze the prescription of high-potency (WHO step III) opioids with respect to regional differences and to assess the proportion of opioid-naïve new users of transdermal fentanyl. METHODS: Prescription claims data of the largest single German health fund (BARMER GEK) with 9.1 million insured persons from the year 2011 were used. For new users of transdermal fentanyl who had had no prescription in the preceding 6 months it was studied whether they had received other high-potency or low-potency opioids before. RESULTS: A total of 18.9 million defined daily doses (DDD) of high-potency opioids were included corresponding to a mean of 208.6 DDD per 100 persons. Significant regional differences were found with lower values in the south, ranging from 145.9 DDD in Baden-Württemberg to 259.5 DDD per 100 persons in Lower Saxony. Fentanyl was the most frequently used step III opioid (40.8% of DDDs) which is nearly only given transdermally. Of the 11,184 patients with new use of transdermal fentanyl 80.7% had received no other high-potency opioid before and 52.9% had received neither low-potency nor high-potency opioids before. The first prescription exceeded the smallest available dose of 12.5 μg/h for over half of the patients starting treatment. CONCLUSIONS: Although oral morphine, oxycodone and hydromorphone are recommended as first-line step III opioids, transdermal fentanyl seems to be prescribed too often as the first choice and might not be appropriate.
BACKGROUND: The aim of this study was to analyze the prescription of high-potency (WHO step III) opioids with respect to regional differences and to assess the proportion of opioid-naïve new users of transdermal fentanyl. METHODS: Prescription claims data of the largest single German health fund (BARMER GEK) with 9.1 million insured persons from the year 2011 were used. For new users of transdermal fentanyl who had had no prescription in the preceding 6 months it was studied whether they had received other high-potency or low-potency opioids before. RESULTS: A total of 18.9 million defined daily doses (DDD) of high-potency opioids were included corresponding to a mean of 208.6 DDD per 100 persons. Significant regional differences were found with lower values in the south, ranging from 145.9 DDD in Baden-Württemberg to 259.5 DDD per 100 persons in Lower Saxony. Fentanyl was the most frequently used step III opioid (40.8% of DDDs) which is nearly only given transdermally. Of the 11,184 patients with new use of transdermal fentanyl 80.7% had received no other high-potency opioid before and 52.9% had received neither low-potency nor high-potency opioids before. The first prescription exceeded the smallest available dose of 12.5 μg/h for over half of the patients starting treatment. CONCLUSIONS: Although oral morphine, oxycodone and hydromorphone are recommended as first-line step III opioids, transdermal fentanyl seems to be prescribed too often as the first choice and might not be appropriate.
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