Addressing and Reducing Opioid Use Among Patients With Shingles

^{By Julie Gould}

Jessica DeMartino, PhD, Manager, Health Outcomes Insights and Solutions, Vaccines US Health Outcomes, GSK, reviews her recent research that examined opioid use and painkiller treatment patterns among patients with shingles, and explains the significance of the findings that showed that one opioid prescription is estimated to be avoided for every 19 patients vaccinated with a recombinant zoster vaccine.

What existing data led you and your co-investigators to conduct this research? 

Our interest in the topic of opioids to treat herpes zoster (HZ), or shingles, and post herpetic neuralgia (PHN) pain was initially due to interest in the topic from the Department of Veterans Affairs and how they could reduce the use of opioids in their population. We conducted a literature search to see what was known about the use of opioids in patients with HZ and/or PHN. While there were a few posters and publications, there was a lack of a comprehensive picture of opioid use in patients with HZ and/or PHN.  

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising? 

We conducted a retrospective claims database study using the Truven MarketScan databases (Commercial, Medicare, and Medicaid) to look at painkiller treatment patterns in HZ patients, factors associated with receipt of an opioid, and incremental health care resource utilization and costs associated with opioid use in patients with HZ. The study period was August 1, 2013 to July 31, 2018.  

Using the results from the database portion of the study, we developed a calculator to estimate the impact of vaccinating members of a population over 50 years of age and older with recombinant zoster vaccine (RZV; Shingrix) on painkiller prescription related outcomes.

Over 25% of patients with HZ in our study were prescribed opioids, with the majority of these patients receiving weak opioids. On average, there were 1.6 opioid prescriptions for each HZ patient in the 12 month follow up period. Regardless of the time period after the HZ index date, the adjusted health care costs in the group of patients who received opioids tended to be approximately double the adjusted health care costs in the group of patients that did not receive opioids. A diagnosis of PHN was the strongest predictor of opioid therapy, while the likelihood of receiving opioid therapy tended to decrease in later calendar years of the study. 

The calculator estimates that in a population of 1 million adults aged over 50 years, RZV vaccination could prevent over 19,000 patients from receiving HZ-related opioids, 4,500 patients from receiving benzodiazepines, and 12,000 patients from receiving other analgesics. One opioid prescription is estimated to be avoided for every 19 patients vaccinated with RZV. 

What are the possible real-world applications of these findings in clinical practice?

Even though the number of opioid prescriptions has decreased during recent years, opioids will maintain their therapeutic place in the management of HZ/PHN-related pain. A preventive strategy to decrease shingles incidence through RZV vaccination could potentially be effective in reducing HZ-related opioid prescriptions as well as health care resource utilization and health care costs.

Do you and your co-investigators intend to expand upon this research? 

While we have no plans for additional research in this area, we do anticipate our field medical colleagues sharing this information with health care providers to address their questions on the potential benefits of vaccinating with RZV against HZ beyond preventing cases of shingles based on our research study.

References

Poirrier JE, DeMartino JK, Stoddard J, Nagar S, Meyers J. Opioid use and associated costs in pain management practices among herpes zoster patients. Poster presented at AMCP Nexus Virtual, October 19-23, 2020. 

Poirrier JE, Carrico J, DeMartino JK, Hicks KA, Stoddard J, Nagar S, Meyers J. The potential for reducing opioid and analgesic prescriptions via herpes zoster vaccination. Poster presented at ID Week 2020, October 21-25, virtual congress. 

About Dr DeMartino

Dr DeMartino’s role at GlaxoSmithKline is Manager, Health Outcomes Insights and Solutions, Vaccines. In this role at GSK, she serves as the interface between health outcomes scientific staff and field medical colleagues, supporting the herpes zoster, influenza, and meningococcal franchises. Dr DeMartino received her PhD in organic chemistry from The Scripps Research Institute, and BS in Biochemistry from the University of Delaware. After graduate school, she spent 7+ years at the National Comprehensive Cancer Network (NCCN) as the Manager of Health Policy Programs focused on topics such as biosimilars, molecular testing, and health care reform. She then spent the next 15 months at ECRI Institute, a health care technology assessment organization, as Director, Health Policy Initiatives, focusing on misuse of opioids and health information technology before joining GSK in April 2017.