Table 1. Patient Characteristics for Prematch and Postmatched Patient Cohorts.
| Characteristic | Final prematch cohort 24 mo | Final postmatch cohort 24 mo | ||||||
|---|---|---|---|---|---|---|---|---|
| No. (%) | SMD | No. (%) | SMD | |||||
| Total (n = 92 726) | SCS (n = 1419) | CMM (n = 91 307) | Total (n = 7560) | SCS (n = 1260) | CMM (n = 6300) | |||
| Age, mean (SD), y | 61.9 (13.3) | 64.3 (11.9) | 61.9 (13.3) | 0.19 | 63.5 (12.5) | 64.0 (12.1) | 63.4 (12.5) | 0.05 |
| Age category | ||||||||
| 18-54 | 25 048 (27.0) | 288 (20.3) | 24 760 (27.1) | −0.16 | 1715 (22.7) | 263 (20.9) | 1452 (23.1) | −0.05 |
| 55-64 | 25 953 (28.0) | 379 (26.7) | 25 574 (28.0) | −0.03 | 2033 (26.9) | 342 (27.1) | 1691 (26.8) | 0.01 |
| 65-74 | 25 321 (27.3) | 463 (32.6) | 24 858 (27.2) | 0.12 | 2270 (30.0) | 400 (31.8) | 1870 (29.7) | 0.04 |
| 75+ | 16 404 (17.7) | 289 (20.4) | 16 115 (17.7) | 0.07 | 1542 (20.4) | 255 (20.2) | 1287 (20.4) | −0.00 |
| Sex | ||||||||
| Male | 36 379 (39.2) | 561 (39.5) | 35 818 (39.2) | 0.01 | 3080 (40.7) | 493 (39.1) | 2587 (41.1) | −0.04 |
| Female | 56 347 (60.8) | 858 (60.5) | 55 489 (60.8) | −0.01 | 4480 (59.3) | 767 (60.9) | 3713 (58.9) | 0.04 |
| Insurance type | ||||||||
| Commercially insured | 29 417 (31.7) | 353 (24.9) | 29 064 (31.8) | −0.15 | 2101 (27.8) | 315 (25.0) | 1786 (28.4) | −0.08 |
| Medicare Advantage | 63 309 (68.3) | 1066 (75.1) | 62 243 (68.2) | 0.15 | 5459 (72.2) | 945 (75) | 4514 (71.7) | 0.08 |
| Geographic location | ||||||||
| Northeast | 7565 (8.2) | 76 (5.4) | 7489 (8.2) | −0.11 | 489 (6.5) | 74 (5.9) | 415 (6.6) | −0.03 |
| Midwest | 18 153 (19.6) | 411 (29.0) | 17 742 (19.4) | 0.22 | 2073 (27.4) | 342 (27.1) | 1731 (27.5) | −0.01 |
| South | 55 794 (60.2) | 729 (51.4) | 55 065 (60.3) | −0.18 | 3971 (52.5) | 671 (53.3) | 3300 (52.4) | 0.02 |
| West | 11 214 (12.1) | 203 (14.3) | 11 011 (12.1) | 0.07 | 1027 (13.6) | 173 (13.7) | 854 (13.6) | 0.01 |
| Race and ethnicity | ||||||||
| Asian | 1329 (1.4) | <11 (NA)a | >1318 (NA) | −0.08 | 56 (0.7) | <11 (NA) | >45 (NA) | −0.02 |
| Black | 15 148 (16.3) | 157 (11.1) | 14 991 (16.4) | −0.16 | 901 (11.9) | 150 (11.9) | 751 (11.9) | −0.00 |
| Hispanic | 8016 (8.6) | >90 (NA) | >7926 (NA) | −0.08 | 484 (6.4) | >85 (NA) | >399 (NA) | 0.03 |
| White | 65 513 (70.7) | 1114 (78.5) | 64 399 (70.5) | 0.18 | 5888 (77.9) | 973 (77.2) | 4915 (78.0) | −0.02 |
| Unknown/multipleb | 2720 (2.9) | 47 (3.3) | 2673 (2.9) | 0.02 | 231 (3.1) | 41 (3.3) | 190 (3.0) | 0.01 |
| Index year | ||||||||
| 2016 | 23 689 (25.6) | 282 (19.9) | 23 407 (25.6) | −0.14 | 1637 (21.7) | 261 (20.7) | 1376 (21.8) | −0.03 |
| 2017 | 42 662 (46.0) | 664 (46.8) | 41 998 (46) | 0.02 | 3553 (47) | 595 (47.2) | 2958 (47.0) | 0.01 |
| 2018 | 26 375 (28.4) | 473 (33.3) | 25 902 (28.4) | 0.11 | 2370 (31.4) | 404 (32.1) | 1966 (31.2) | 0.02 |
| Cohort entry diagnosis | ||||||||
| Failed back surgery | 22 739 (24.5) | 1028 (72.5) | 21 711 (23.8) | 1.12 | 5352 (70.8) | 892 (70.8) | 4460 (70.8) | 0.00 |
| Complex regional pain | 5239 (5.7) | 123 (8.7) | 5116 (5.6) | 0.12 | 760 (10.1) | 94 (7.5) | 666 (10.6) | −0.11 |
| Chronic pain | 63 790 (68.8) | 398 (28.1) | 63 392 (69.4) | −0.91 | 1938 (25.6) | 365 (29.0) | 1573 (25.0) | 0.09 |
| Other chronic back/extremity pain | 2775 (3.0) | 13 (0.9) | 2762 (3.0) | −0.15 | 63 (0.8) | 12 (1.0) | 51 (0.8) | 0.02 |
| Clinician type on day of cohort entry | ||||||||
| Primary care | 41 097 (44.3) | 222 (15.6) | 40 875 (44.8) | −0.67 | 1299 (17.2) | 207 (16.4) | 1092 (17.3) | −0.02 |
| Anesthesiologist | 32 020 (34.5) | 991 (69.8) | 31 029 (34.0) | 0.77 | 4890 (64.7) | 847 (67.2) | 4043 (64.2) | 0.06 |
| Neurosurgeon | 4808 (5.2) | 141 (9.9) | 4667 (5.1) | 0.18 | 745 (9.9) | 115 (9.1) | 630 (10) | −0.03 |
| Orthopedic surgeon | 4600 (5.0) | 70 (4.9) | 4530 (5.0) | −0.00 | 394 (5.2) | 67 (5.3) | 327 (5.2) | 0.01 |
| Physiatrist | 8317 (9.0) | 157 (11.1) | 8160 (8.9) | 0.07 | 908 (12.0) | 144 (11.4) | 764 (12.1) | −0.02 |
| Other medical physician | 10 720 (11.6) | 65 (4.6) | 10 655 (11.7) | −0.26 | 344 (4.6) | 58 (4.6) | 286 (4.5) | 0.00 |
| Non–medical physician | 3973 (4.3) | 51 (3.6) | 3922 (4.3) | −0.04 | 305 (4.0) | 48 (3.8) | 257 (4.1) | −0.01 |
| Surrogates of baseline pain | ||||||||
| Total baseline filled prescriptions for opioids | ||||||||
| Mean (SD) | 4.2 (4.2) | 4.7 (4.2) | 4.2 (4.2) | 0.12 | 4.5 (4.3) | 4.6 (4.1) | 4.5 (4.3) | 0.02 |
| Median (IQR) | 3 (1-6) | 4 (1-7) | 3 (1-6) | 4 (1-7) | 4 (1-7) | 4 (1-7) | ||
| Average opioid MME baseline | ||||||||
| Mean (SD) | 29.9 (62.6) | 35.5 (68.2) | 29.8 (62.5) | 0.09 | 34.9 (69.1) | 35.5 (69.7) | 34.8 (69.0) | 0.01 |
| Median (IQR) | 8.0 (0.4-30.7) | 12.7 (1.1-38.9) | 7.9 (0.4-30.6) | 10.1 (0.7-38.0) | 12.2 (1.1-38.6) | 9.9 (0.6-37.8) | ||
| Baseline opioid days | ||||||||
| Mean (SD) | 76.5 (68.3) | 85.8 (67.8) | 76.3 (68.3) | 0.14 | 81.1 (68.8) | 84.3 (67.7) | 80.4 (69.0) | 0.06 |
| Median (IQR) | 61 (3-150) | 90 (9-155) | 61 (3-150) | 76 (5-154) | 90 (8-155) | 74 (4-154) | ||
| Baseline quartile of days supply of opioids | ||||||||
| Quartile 1 | 21 980 (23.7) | 291 (20.5) | 21 689 (23.8) | −0.08 | 1706 (22.6) | 264 (21.0) | 1442 (22.9) | −0.05 |
| Quartile 2 | 22 421 (24.2) | 296 (20.9) | 22 125 (24.2) | −0.08 | 1699 (22.5) | 270 (21.4) | 1429 (22.7) | −0.03 |
| Quartile 3 | 24 502 (26.4) | 406 (28.6) | 24 096 (26.4) | 0.05 | 2006 (26.5) | 355 (28.2) | 1651 (26.2) | 0.04 |
| Quartile 4 | 23 823 (25.7) | 426 (30.0) | 23 397 (25.6) | 0.10 | 2149 (28.4) | 371 (29.4) | 1778 (28.2) | 0.03 |
| Epidural and facet corticosteroid injections | 18 178 (19.6) | 610 (43.0) | 17 568 (19.2) | 0.53 | 3003 (39.7) | 507 (40.2) | 2496 (39.6) | 0.01 |
| Radiofrequency ablation | 3325 (3.6) | 126 (8.9) | 3199 (3.5) | 0.22 | 495 (6.6) | 92 (7.3) | 403 (6.4) | 0.04 |
| Spine surgery | 8645 (9.3) | 193 (13.6) | 8452 (9.3) | 0.14 | 853 (11.3) | 159 (12.6) | 694 (11.0) | 0.05 |
| Other nonpharmacologic, nonintervention treatments during baseline | ||||||||
| Physical therapy | 10 170 (11.0) | 152 (10.7) | 10 018 (11.0) | −0.01 | 874 (11.6) | 139 (11.0) | 735 (11.7) | −0.02 |
| Acupuncture | 595 (0.6) | <11 (NA) | >584 (NA) | −0.04 | 27 (0.36) | <11 (NA) | >16 (NA) | 0.01 |
| Chiropractor | 5672 (6.1) | 76 (5.4) | 5596 (6.1) | −0.03 | 422 (5.6) | 69 (5.5) | 353 (5.6) | −0.01 |
| Any nonpharmacologic, nonintervention treatment | 15 047 (16.2) | 219 (15.4) | 14 828 (16.2) | −0.02 | 1235 (16.3) | 199 (15.8) | 1036 (16.4) | −0.02 |
| Pharmacologic treatment during baseline | ||||||||
| Opioids | 70 746 (76.3) | 1128 (79.5) | 69 618 (76.2) | 0.08 | 5854 (77.4) | 996 (79.1) | 4858 (77.1) | 0.05 |
| NSAIDs | 29 921 (32.3) | 458 (32.3) | 29 463 (32.3) | 0.00 | 2507 (33.2) | 416 (33.0) | 2091 (33.2) | −0.00 |
| Muscle relaxants | 27 975 (30.2) | 463 (32.6) | 27 512 (30.1) | 0.05 | 2526 (33.4) | 413 (32.8) | 2113 (33.5) | −0.02 |
| TCA/SNRI antidepressants | 19 536 (21.1) | 446 (31.4) | 19 090 (20.9) | 0.24 | 2141 (28.3) | 370 (29.4) | 1771 (28.1) | 0.03 |
| Gabapentinoids | 34 732 (37.5) | 786 (55.4) | 33 946 (37.2) | 0.37 | 3891 (51.5) | 674 (53.5) | 3217 (51.1) | 0.05 |
| Benzodiazepines | 29 721 (32.1) | 512 (36.1) | 29 209 (32.0) | 0.09 | 2615 (34.6) | 457 (36.3) | 2158 (34.3) | 0.04 |
| Oral steroids | 22 849 (24.6) | 344 (24.2) | 22 505 (24.7) | −0.01 | 1824 (24.1) | 316 (25.1) | 1508 (23.9) | 0.03 |
| Musculoskeletal comorbidities | ||||||||
| Fibromyalgia | 7199 (7.8) | 114 (8.0) | 7085 (7.8) | 0.01 | 542 (7.2) | 101 (8.0) | 441 (7) | 0.04 |
| Spine disk disease | 66 987 (72.2) | 1339 (94.4) | 65 648 (71.9) | 0.63 | 7074 (93.6) | 1181 (93.7) | 5893 (93.5) | 0.01 |
| Traumatic spine injury | 6057 (6.5) | 129 (9.1) | 5928 (6.5) | 0.10 | 595 (7.9) | 111 (8.8) | 484 (7.7) | 0.04 |
| Osteoporosis | 5544 (6.0) | 89 (6.3) | 5455 (6.0) | 0.01 | 486 (6.4) | 76 (6.0) | 410 (6.5) | −0.02 |
| Osteoarthritis | 14 182 (15.3) | 320 (22.6) | 13 862 (15.2) | 0.19 | 1579 (20.9) | 275 (21.8) | 1304 (20.7) | 0.03 |
| Mental health comorbidities | ||||||||
| Anxiety | 23 530 (25.4) | 406 (28.6) | 23 124 (25.3) | 0.07 | 2124 (28.1) | 359 (28.5) | 1765 (28.0) | 0.01 |
| History of benzodiazepine use disorder | 538 (0.6) | 11 (0.8) | 527 (0.6) | 0.02 | 43 (0.6) | 11 (0.9) | 32 (0.5) | 0.04 |
| Alcohol use disorder | 2090 (2.3) | 21 (1.5) | 2069 (2.3) | −0.06 | 132 (1.75) | 20 (1.59) | 112 (1.78) | −0.01 |
| Depression | 22 706 (24.5) | 660 (46.5) | 22 046 (24.1) | 0.48 | 2999 (39.7) | 515 (40.9) | 2484 (39.4) | 0.03 |
| Psychosis | 1466 (1.6) | 13 (0.9) | 1453 (1.6) | −0.06 | 73 (1.0) | 13 (1.0) | 60 (1.0) | 0.01 |
| Substance abuse disorder | 9168 (9.9) | 156 (11.0) | 9012 (9.9) | 0.04 | 797 (10.5) | 136 (10.8) | 661 (10.5) | 0.01 |
| Other comorbidities | ||||||||
| Pregnancy | 264 (0.3) | 0 (0.0) | 264 (0.3) | −0.08 | NA (NA) | NA (NA) | NA (NA) | −0.02 |
| Blood loss anemia | 1097 (1.2) | 12 (0.9) | 1085 (1.2) | −0.03 | 58 (0.8) | 11 (0.9) | 47 (0.8) | 0.01 |
| Cardiac arrhythmias | 13 024 (14.1) | 222 (15.6) | 12 802 (14.0) | 0.05 | 1069 (14.1) | 198 (15.7) | 871 (13.8) | 0.05 |
| Congestive heart failure | 8112 (8.8) | 114 (8.0) | 7998 (8.8) | −0.03 | 507 (6.7) | 107 (8.5) | 400 (6.4) | 0.08 |
| Coagulopathy | 2401 (2.6) | 44 (3.1) | 2357 (2.6) | 0.03 | 189 (2.5) | 37 (2.9) | 152 (2.4) | 0.03 |
| Chronic pulmonary disease | 22 193 (23.9) | 341 (24.0) | 21 852 (23.9) | 0.00 | 1768 (23.4) | 311 (24.7) | 1457 (23.1) | 0.04 |
| Deficiency anemia | 5795 (6.3) | 81 (5.7) | 5714 (6.3) | −0.02 | 396 (5.2) | 77 (6.1) | 319 (5.1) | 0.05 |
| Diabetes, uncomplicated | 23 380 (25.2) | 371 (26.2) | 23 009 (25.2) | 0.02 | 1923 (25.4) | 336 (26.7) | 1587 (25.2) | 0.03 |
| Diabetes, complicated | 17 133 (18.5) | 267 (18.8) | 16 866 (18.5) | 0.01 | 1407 (18.6) | 243 (19.3) | 1164 (18.5) | 0.02 |
| Diabetes | 27 257 (29.4) | 432 (30.4) | 26 825 (29.4) | 0.02 | 2227 (29.5) | 390 (31.0) | 1837 (29.2) | 0.04 |
| Fluid and electrolyte disorders | 9125 (9.8) | 106 (7.5) | 9019 (9.9) | −0.09 | 555 (7.3) | 98 (7.8) | 457 (7.3) | 0.02 |
| HIV | 379 (0.4) | <11 (NA) | >368 (NA) | −0.02 | 21 (0.3) | <11 (NA) | >10 (NA) | −0.01 |
| Hypertension, uncomplicated | 55 671 (60.0) | 913 (64.3) | 54 758 (60.0) | 0.09 | 4684 (62.0) | 811 (64.4) | 3873 (61.5) | 0.06 |
| Hypertension, complicated | 9503 (10.3) | 126 (8.9) | 9377 (10.3) | −0.05 | 626 (8.3) | 116 (9.2) | 510 (8.1) | 0.04 |
| Hypertension | 56 886 (61.4) | 934 (65.8) | 55 952 (61.3) | 0.09 | 4766 (63.0) | 830 (65.9) | 3936 (62.5) | 0.07 |
| Hypothyroidism | 15 392 (16.6) | 259 (18.3) | 15 133 (16.6) | 0.04 | 1294 (17.1) | 230 (18.3) | 1064 (16.9) | 0.04 |
| Liver disease | 4602 (5.0) | 73 (5.1) | 4529 (5.0) | 0.01 | 382 (5.1) | 63 (5) | 319 (5.1) | −0.00 |
| Obesity | 15 034 (16.2) | 251 (17.7) | 14 783 (16.2) | 0.04 | 1276 (16.9) | 221 (17.5) | 1055 (16.8) | 0.02 |
| Other neurological deficits | 5950 (6.4) | 88 (6.2) | 5862 (6.4) | −0.01 | 428 (5.7) | 77 (6.1) | 351 (5.6) | 0.02 |
| Pulmonary circulation disorders | 2383 (2.6) | 31 (2.2) | 2352 (2.6) | −0.03 | 146 (1.9) | 29 (2.3) | 117 (1.9) | 0.03 |
| Peptic ulcer disease | 1091 (1.2) | 18 (1.3) | 1073 (1.2) | 0.01 | 93 (1.2) | 16 (1.3) | 77 (1.2) | 0.00 |
| Peripheral vascular disease | 9948 (10.7) | 152 (10.7) | 9796 (10.7) | −0.00 | 733 (9.7) | 135 (10.7) | 598 (9.5) | 0.04 |
| Paralysis | 1012 (1.1) | <11 (NA) | >1001 (NA) | −0.06 | 41 (0.54) | <11 (NA) | >30 (NA) | 0.01 |
| Kidney failure | 9377 (10.1) | 142 (10.0) | 9235 (10.1) | −0.00 | 698 (9.2) | 129 (10.2) | 569 (9.0) | 0.04 |
| Valvular disease | 5981 (6.5) | 85 (6.0) | 5896 (6.5) | −0.02 | 457 (6.0) | 74 (5.9) | 383 (6.1) | −0.01 |
| Weight loss | 2771 (3.0) | 31 (2.2) | 2740 (3) | −0.05 | 166 (2.2) | 28 (2.2) | 138 (2.2) | 0.00 |
| Health care utilization and costs | ||||||||
| All-cause cost of care, $ | ||||||||
| Baseline total costs, PMPM | ||||||||
| Mean (SD) | 2261 (4639) | 2003 (3513) | 2265 (4654) | −0.06 | 2138 (4241) | 1993 (3487) | 2167 (4376) | −0.04 |
| Median (IQR) | 958 (436-2312) | 1162 (646-2181) | 954 (433-2316) | 1060 (557-2253) | 1139 (619-2142) | 1045 (544-2283) | ||
| Baseline medical costs, PMPM | ||||||||
| Mean (SD) | 1718 (4292) | 1406 (3288) | 1723 (4306) | −0.08 | 1550 (3570) | 1389 (3242) | 1582 (3632) | −0.06 |
| Median (IQR) | 542 (222-1496) | 691 (371-1324) | 539 (221-1501) | 625 (310-1429) | 679 (363-1300) | 613 (300-1464) | ||
| Baseline outpatient pharmacy costs, PMPM | ||||||||
| Mean (SD) | 543 (1595) | 597 (1031) | 542 (1603) | 0.04 | 588 (2215) | 604 (1064) | 585 (2379) | 0.01 |
| Median (IQR) | 193 (71-532) | 275 (107-662) | 192 (70-530) | 229 (86-602) | 281 (102-665) | 219 (83-590) | ||
| All-cause health care resource utilization | ||||||||
| Baseline emergency department stays | ||||||||
| Mean (SD) | 0.6 (1.4) | 0.5 (1.2) | 0.6 (1.4) | −0.09 | 0.5 (1.3) | 0.5 (1.2) | 0.5 (1.3) | −0.04 |
| Median (IQR) | 0 (0-1) | 0 (0-1) | 0 (0-1) | 0 (0-1) | 0 (0-1) | 0 (0-1) | ||
| Baseline emergency department days | ||||||||
| Mean (SD) | 0.7 (3.4) | 0.6 (1.5) | 0.7 (3.4) | −0.07 | 0.6 (1.7) | 0.5 (1.5) | 0.6 (1.8) | −0.06 |
| Median (IQR) | 0 (0-1) | 0 (0-1) | 0 (0-1) | 0 (0-1) | 0 (0-1) | 0 (0-1) | ||
| Baseline inpatient stays | ||||||||
| Mean (SD) | 0.2 (0.6) | 0.1 (0.4) | 0.2 (0.6) | −0.20 | 0.1 (0.4) | 0.1 (0.4) | 0.2 (0.4) | −0.09 |
| Median (IQR) | 0 | 0 | 0 | 0 | 0 | 0 | ||
Abbreviations: MME, morphine milligram equivalent; NA, not available; NSAID, nonsteroidal anti-inflammatory drug; PMPM, per member per month; SMD, standardized mean difference; SNRI, serotonin and norepinephrine reuptake inhibitor; TCA, tricyclic antidepressant.
a
Small numbers (n <11) cannot be reported according to the Optum Labs cell size suppression policy.
b
Unknown/multiple refers to patients with unknown race or ethnicity or included in multiple categories.