Duloxetine use in employees with low back pain: Treatment patterns and direct and indirect costs

Abstract

Objective: The study aims to examine real-world effects of duloxetine treatment for low back pain (LBP). Methods: The study identified employees with ≥1 LBP diagnosis and ≥1 duloxetine prescription within a year after LBP diagnosis from a privately insured claims database (2004-2007). Duloxetine-treated employees were propensity score matched to employees initiating another pharmacological/noninvasive treatment in the same month from LBP diagnosis. Treatment patterns and costs were compared over the 6 months following treatment initiation. Results: Relative to controls, duloxetine-treated employees (N=753) had significantly lower rates of other pharmacological/noninvasive therapies and a similar LBP surgery rate (1.7% vs 2.8%, P=0.1573). Duloxetine-treated employees, despite higher pharmacy costs, had similar direct (health care) costs ($4,935 vs $5,649, P=0.2662), and significantly lower indirect (workloss) costs ($1,723 vs $2,198, P=0.0036). Conclusions: Duloxetine treatment in LBP employees was associated with reduced rates of many nonsurgical therapies and lower indirect costs. The findings are limited by the observational study design and unmeasured potential confounders. © 2014 American Academy of Pain Medicine.