Background Determining risk factors for opioid abuse or dependence will help clinicians practice informed prescribing and may help mitigate opioid abuse or dependence. The purpose of this study is to identify variables predicting opioid abuse or dependence. Methods A retrospective cohort study using de-identified integrated pharmacy and medical claims between October 2009 and September 2013. Patients with at least one opioid prescription claim during the index period (index claim) were identified. We ascertained risk factors using data from 12 months prior to index claim (pre-period) and captured abuse or dependency diagnosis using data from 12 months post index claim (post-period). We included continuously eligible (pre- and post-period) commercially insured patients aged 18 or older. We excluded patients with cancer, residence in a long-term care facility, or previous diagnosis of opioid abuse or dependence (identified by International Classification of Diseases-9th revision (ICD-9) code or buprenorphine/naloxone claim in the pre-period). The outcome was a diagnosis of opioid abuse (ICD9 code 304.0×) or dependence (305.5). Results The final sample consisted of 694,851 patients. Opioid abuse or dependence was observed in 2,067 patients (0.3%). Several factors predicted opioid abuse or dependence: younger age [per decade (older) odds ratio (OR) 0.68], being a chronic opioid user [OR 4.39], history of mental illness [OR 3.45], non-opioid substance abuse [OR 2.82], alcohol abuse [OR 2.37], high morphine equivalent dose per day user [OR 1.98], tobacco use [OR 1.80], obtaining opioids from multiple prescribers [OR 1.71], residing in the South [OR 1.65], West [OR 1.49], or Midwest [OR 1.24], using multiple pharmacies [OR 1.59], male gender [OR 1.43], and increased 30-day adjusted opioid prescriptions [OR 1.05]. Conclusions Readily available demographic, clinical, behavioral, pharmacy and geographic information can be used to predict likelihood of opioid abuse or dependence.

After excluding patients who received any prescriptions via home delivery auto refill programs and controlling for PAB, differences in days supply, low-income subsidy status, demographics, and disease burden, Medicare beneficiaries who use home delivery for antidiabetics, antihypertensives, or antihyperlipidemics have a greater likelihood of being adherent than patients who fill their prescriptions at retail. The results of this study provide evidence that where medications are received may impact adherence, even when controlling for PAB. Use of the home delivery dispensing channel may be an effective method to improve adherence for Medicare beneficiaries.

informCLL is the first United States-based registry of patients with chronic lymphocytic leukemia that initiated enrollment after approval of novel targeted agents. Prognostic/predictive testing rates and chronic lymphocytic leukemia treatment selection with availability of novel agents have not been previously investigated in clinical practice. Results from this interim analysis demonstrate that prognostic/predictive testing was infrequently used to guide treatment selection, potentially inhibiting beneficial outcomes for patients. Introduction: The therapeutic landscape for chronic lymphocytic leukemia (CLL) has significantly shifted with the approval of novel agents. Understanding current prognostic testing and treatment practices in this new era is critical. Beginning enrollment in 2015, informCLL is the first United States-based real-world, prospective, observational registry that initiated enrollment after approval of novel agents. Patients and Methods: Eligible patients were age ≥ 18 years, started CLL treatment within 30 days of enrollment, and provided consent. For this planned interim analysis, treatments were classified into 5 groups: ibrutinib, chemoimmunotherapy, chemotherapy, immunotherapy, and other novel agents. Results: Frequency of prognostic testing and treatment patterns are reported among 840 patients (459 previously untreated; 381 relapsed/refractory), enrolled largely (96%) from community practice settings. Testing for chromosomal abnormalities by fluorescence in situ hybridization, TP53 mutation, or IGHV mutation status occurred infrequently among all patients (31%, 11%, and 11%, respectively). Chemoimmunotherapy was the most common treatment in previously untreated patients (42%), whereas ibrutinib was the most common treatment among relapsed/ refractory patients (51%). Of patients who tested positive for del(17p) or TP53 mutation, 34% and 26% received chemoimmunotherapy, respectively. Among patients who did not have fluorescence in situ hybridization or TP53 mutation testing prior to enrollment, 33% and 32% received chemoimmunotherapy, respectively. Conclusion: Our findings indicate that prognostic testing rates were poor, and approximately one-third of high-risk patients (del[17p] and TP53) received chemoimmunotherapy, which is not aligned with current CLL treatment recommendations. This represents an opportunity to educate and alert health care professionals about the necessity of prognostic testing to guide optimal CLL treatment decisions.

Funding for this study was provided internally by Express Scripts Holding Company. Iyengar, LeFrancois, Henderson, and Rabbitt are employees of Express Scripts. Study concept and design were created by Iyengar and LeFrancois. Iyengar was responsible for acquisition of data, statistical analysis, and interpretation of data. The manuscript was written by Iyengar and LeFrancois and revised by all the authors.