OA Leads to Higher STD Costs – Especially When Opioids are in the Mix

Sarasota, FL (WorkersCompensation.com) – Opioid prescriptions have generally been declining in recent years – except when it comes to osteoarthritis (OA). The problem is the lack of alternative treatment options available.

OA is among the most common musculoskeletal disorders and is on the rise in the U.S. It creates pain and stiffness in the joints, leading to chronic pain and functional disability. With increased severity, there is a strong association with decreased productivity, increased work absence and higher unemployment. OA is also among the most costly chronic conditions for employers, especially short-term disability and general healthcare disability days and costs. One of the main drivers is the use of opioids.

“Though their use is discouraged in treatment guidelines, opioids are one of the most common prescription medications provided to employees with OA in the U.S.,” said a new study. “Yet, opioids provide minimal improvements in pain and function for employees with OA and are associated with further increases in healthcare costs/utilization and lost wages.”

In a study funded by Pfizer and Eli Lilly and Company, researchers compared OA claims of STD, workers’ compensation and general healthcare lost days and costs to those of other chronic conditions. They additionally looked at the impact of opioids. Writing in the Journal of Occupational and Environmental Medicine, the authors point to the importance of considering what therapies should be prescribed to employees with OA and chronic musculoskeletal pain.

Study and Findings

The authors set out to compare lost days and payments for STD and workers’ compensation as well as direct healthcare payments between workers with OA and those with other chronically painful conditions.

The retrospective, non-interventional database analysis included claims figures from the IBM MarketScan Research Databases from a non-random sample of large employers’ healthcare/disability insurance claims throughout the U.S. for the years 2014 – 2017. There were 144,355 claims among employees with OA, and 392,639 in the control group. 

Claims involving OA had an estimated addition of 1.2 STD days, $152 STD payments and $1,420 healthcare payments compared to those without OA.

“Findings from this retrospective, non-interventional database analysis demonstrate that U.S. employees with OA had an estimated 90% higher incidence of STD days, 96% higher STD payments, and 9% higher healthcare payments than a control cohort of employees with other chronically painful conditions,” the authors wrote. “These data demonstrate the particular importance of OA as a cause of disability lost workdays, associated wage replacements, and healthcare payments in the context of other chronically painful conditions.”

However, they also found there was not a significant impact on workers’ compensation days or payments. In fact, the study showed lower risk of workers’ compensation days and payments among employees with OA compared with other chronically painful conditions. The authors pointed out that they found almost no workers’ compensation claims for OA in either group.

“Employees with chronic pain might be less likely to claim workers’ compensation than employees in the general population due to the ‘healthy worker effect’ – where ‘unhealthy’ employees (those with physical limitations) are less likely to take physically demanding jobs, thus are less likely to incur work-related injuries and also find it easier to stay at work after an injury (for example on light duties) because of the nature of their job and workplace,” the researchers surmised. “This effect might be occurring more commonly in our cohort with other chronically painful conditions (mainly non-OA joint pain, back pain, or limb pain). It has been suggested that factors other than comorbidities, such as age, can have a considerable role to play in the costs associated with work-related injuries; however, age was controlled for in our models.”

The Opioid Factor

The increased number of STD lost days and costs as well as higher general healthcare costs among employees with OA was especially pronounced when opioids were prescribed. The study showed opioid use was a significant predictor for all outcomes, especially STD days/payments and healthcare payments.

“On average, employees not prescribed opioids had about 0.4 workers’ compensation days and about 0.8 STD days,” according to the study. “Employees prescribed opioids had an additional 0.5 workers’ compensation days and an additional 3.8 STD days. Employees prescribed opioids also had an additional $163 in workers’ compensation payments, $520 in additional STD payments, and $12,239 in additional healthcare payments.”

The estimated mean number of disability days associated with OA is not necessarily as high as that for other chronic conditions, such as spinal injury or loss of limb. However, the high prevalence of OA can ultimately result in a large financial hit for employers. The estimated additional $1,410 in healthcare spending included payments for inpatient, outpatient and prescriptions, over a mean observation period of 33 months.

“The reasons that opioids are associated with negative outcomes in people with chronic pain (including pain due to OA) are likely multifactorial,” the authors noted. “Opioids have been shown to provide no additional benefit in pain related function over non-opioid medications for people with back pain and OA and are associated with more adverse effects. The known adverse effect profile and risk of addiction associated with opioids likely contributes to the negative work productivity outcomes observed in our analysis.”

The researchers suggest stakeholders consider alternatives to opioids for employees with OA and chronic musculoskeletal pain.

“Our findings add to the growing evidence of a significant association between OA, opioid use, and increased work absence,” they concluded. “OA was associated with a higher incidence of work productivity loss, and higher short-term disability and healthcare payments, than a comparator cohort including a broad selection of other chronically painful conditions. The use of opioids was a key driver in this finding.”

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