The direct and indirect costs of opioid-induced constipation

J Pain Symptom Manage. 2010 Nov;40(5):696-703. doi: 10.1016/j.jpainsymman.2010.02.019. Epub 2010 Aug 21.


Context: Treatment with strong opioids is connected with frequent and problematic side effects. One of the most common side effects is opioid-induced constipation (OIC). The discomfort of OIC can limit the effectiveness of pain therapy. Because constipation typically persists for as long as opioid therapy is administered, its effects on the quality of life (QoL) of patients need to be taken seriously. Data and published studies on the cost implications of OIC are, however, scarce.

Objectives: To estimate the direct and indirect costs of OIC in a defined patient population during treatment with strong opioids.

Methods: The study is based on patient data from a Swedish noninterventional study, UPPSIKT. The cost analysis is based on 197 patients treated with strong opioids over a six-month period. Direct and indirect costs in this article are calculated per patient-month, and the cost for OIC is estimated as the difference in mean costs between months with and without constipation.

Results: The total costs per patient-month for patients with severe constipation are significantly higher than those for patients with mild, moderate, or no constipation. Patients with severe constipation have the highest total costs, Euro (EUR) 1525 per patient-month, whereas patients with mild, moderate, and no problems cost EUR 1196, EUR 1088, and EUR 1034, respectively.

Conclusion: Opioid use is costly to society, and the costs vary with OIC severity. OIC is discomforting, affects the QoL of patients, and can limit an effective pain therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / economics*
  • Analysis of Variance
  • Constipation / chemically induced
  • Constipation / economics*
  • Female
  • Health Care Costs
  • Humans
  • Male
  • Middle Aged
  • Pain / drug therapy
  • Pain / economics*
  • Patient Satisfaction
  • Quality of Life
  • Severity of Illness Index
  • Sweden


  • Analgesics, Opioid