Economic impact of potential CYP450 pharmacokinetic drug-drug interactions among chronic low back pain patients taking opioids

Pain Pract. 2012 Jan;12(1):45-56. doi: 10.1111/j.1533-2500.2011.00503.x. Epub 2011 Sep 16.


Chronic low back pain (cLBP) patients who take at least 1 CYP450-metabolized opioid analgesic agent concurrent with at least 1 other CYP450-metabolized medication experience a drug-drug exposure (DDE), which puts them at risk for a pharmacokinetic drug-drug interaction (PK DDI). This study compared utilization of healthcare resources and associated payments in cLBP patients with and without incident DDEs with the potential to cause PK DDIs. A retrospective database analysis examined the associated clinical events, healthcare utilization (measured in terms of claims for office visits, outpatient visits, emergency department visits, and hospitalization), and cost to the health plan, as defined as the sum of health plan payments for resources used. Patients were grouped into 2 cohorts by age (those under 65 and those 65 years and over). In the 6 months after exposure, total healthcare payments were significantly higher for DDE patients than those without DDEs (no-DDE), in both in the younger ($7,086, SD = $8,370) and $6,353, SD = $8,352, respectively, P < 0.001) and the older cohorts ($7,806 vs. $7,043, respectively, P = 0.013). Younger and older patients with DDE had significantly higher prescription payments than those without DDE ($2,041, SD = $2,706 vs. $1,565, SD = $2,349, respectively, P < 0.001 for younger and $2,482, SD = $2,481 vs. $2,286, SD = $2,521, respectively, P = 0.044 for older patients). Both older and younger patients with DDE had significantly more claims for office visits and higher associated payments than similar patients without DDE. Patients in the study who experienced DDEs that placed them at risk for PK DDIs had significantly greater utilization rates of healthcare resources and higher associated payments in the 6-month observation period following exposure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Analgesics, Opioid / economics*
  • Analgesics, Opioid / pharmacokinetics
  • Analgesics, Opioid / therapeutic use
  • Cytochrome P-450 Enzyme System / metabolism
  • Drug Interactions*
  • Female
  • Health Services / economics
  • Hospitalization / economics
  • Humans
  • Low Back Pain / drug therapy*
  • Low Back Pain / economics*
  • Male
  • Middle Aged
  • Office Visits / economics
  • Retinoic Acid 4-Hydroxylase


  • Analgesics, Opioid
  • Cytochrome P-450 Enzyme System
  • Retinoic Acid 4-Hydroxylase