HealthCore: 20 Years of Real-World Evidence

Opioid Use Among Adolescent Patients Treated for Headache

HealthCore has been developing actionable real-world evidence (RWE) for regulators, payers and life sciences industry innovators for more than two decades. So, it was heartening to see a multi-disciplinary Food and Drug Administration (FDA) team reaffirm the expanding value of RWE in medical product development in an article in New England Journal of Medicine on December 8.

Increasingly, real-world data environments like HealthCore’s are being used to guide clinical and economic decisions and actions around pressing healthcare questions for a broadening set of healthcare stakeholders. One example is a recent study we conducted evaluating opioids in pain control, an obviously problematic area that has become one key area of focus for our team especially in their use as first line treatment to manage headaches among adolescents. HealthCore collaborated with our parent, Anthem, the American Academy of Pediatrics, the American Academy of Family Physicians and the American Academy of Neurology for a cohort study on opioid prescribing patterns in this patient population. We also examined how actual pediatric headache treatment patterns aligned with American Academy of Neurology guidelines.

Using administrative claims from the HealthCore Integrated Database, our study evaluated more than 8,000 patients whose age ranged from 13-17 years and found that 46 percent of the study patients who complained of headache received an opioid prescription.  Among patients who received a prescription, nearly one-half received only one prescription; a quarter received two prescriptions, and nearly a third received three or more prescriptions.

Although it was known that adolescents received opioids for headache treatment contrary to guideline recommendations, our study showed that the rates of opioid prescription in this population were much higher than previously reported. This is contrary to prior research, which examined prescribing within four emergency departments, and revealed that opioids were used in 12 percent of cases overall, and in only 6 percent as first-line therapy.

Opioid prescriptions for this population should be relatively low because while opioids are effective in relieving pain, they are suboptimal treatments for migraine. In fact, the American Academy of Neurology states that opioids should only be used as rescue therapy for acute migraine in very specific situations. Additionally, medical guidelines recommend non-steroidal anti-inflammatory drugs or triptans as first-line therapy.

RWE facilitates more timely and realistic adjustment of policies and regulations, while helping to target educational resources more effectively. This RWE study uncovered a large gap between what was assumed to be true and what was the reality, which has implications for the effectiveness of medical interventions and patient safety. Insights from this study prompted Anthem to raise awareness and to disseminate these results broadly within its provider network. It is hoped that this increased awareness will help reduce the risk of opioid abuse among adolescents.

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