Abstract
BackgroundPrevious studies on high-risk opioid use have only focused on patients diagnosed with an opioid disorder. This study evaluates the impact of various high-risk prescription opioid use groups on healthcare costs and utilization.MethodsThis is a retrospective cohort study using QuintilesIMS health plan claims with independent variables from 2012 and outcomes from 2013. We included a population-based sample of 191,405 non-elderly adults with known sex, one or more opioid prescriptions, and continuous enrollment in 2012 and 2013. Three high-risk opioid use groups were identified in 2012 as (1) persons with 100+ morphine milligram equivalents per day for 90+ consecutive days (chronic users); (2) persons with 30+ days of concomitant opioid and benzodiazepine use (concomitant users); and (3) individuals diagnosed with an opioid use disorder. The length of time that a person had been characterized as a high-risk user was measured. Three healthcare costs (total, medical, and pharmacy costs) and four binary utilization indicators (the top 5% total cost users, the top 5% pharmacy cost users, any hospitalization, and any emergency department visit) derived from 2013 were outcomes. We applied a generalized linear model (GLM) with a log-link function and gamma distribution for costs while logistic regression was employed for utilization indicators. We also adopted propensity score weighting to control for the baseline differences between high-risk and non-high-risk opioid users.ResultsOf individuals with one or more opioid prescription, 1.45% were chronic users, 4.81% were concomitant users, and 0.94% were diagnosed as having an opioid use disorder. After adjustment and propensity score weighting, chronic users had statistically significant higher prospective total (40%), medical (3%), and pharmacy (172%) costs. The increases in total, medical, and pharmacy costs associated with concomitant users were 13%, 7%, and 41%, and 28%, 21% and 63% for users with a diagnosed opioid use disorder. Both total and pharmacy costs increased with the length of time characterized as high-risk users, with the increase being statistically significant. Only concomitant users were associated with a higher odds of hospitalization or emergency department use.ConclusionsIndividuals with high-risk prescription opioid use have significantly higher healthcare costs and utilization than their counterparts, especially those with chronic high-dose opioid use.
Highlights
Previous studies on high-risk opioid use have only focused on patients diagnosed with an opioid disorder
One review estimated that individuals with an opioid use disorder had annual healthcare costs that were $14,054–$20,546 greater than their counterparts among the privately insured, while commensurate increases among those with Medicaid ranged from $5870 to $15,183 per year [8]
Characteristics of the eligible participants Of 893,835 eligible enrollees, we identified 0.31% chronic users, 1.03% concomitant users, and 0.27% individuals with a diagnosis of an opioid disorder (Table 1)
Summary
Previous studies on high-risk opioid use have only focused on patients diagnosed with an opioid disorder. More recent studies suggest similar additional expenses associated with opioid use disorders, ranging from $10,627 [9] to $20,760 [10] per year This problem is not unique to the United States; for example, across the five largest European countries, the estimates of the incremental healthcare costs associated with prescription opioid abuse ranged from €900 to €2551 per person per year [11]. Despite insights from prior studies, many analyses have adopted diagnosis codes rather than prescription drug utilization to identify high-risk opioid users [9, 10, 12,13,14,15,16,17], yet the vast majority of individuals with opioid use disorders are yet to be diagnosed. In many analyses, comparisons between high-risk users and their counterparts have not been well controlled, increasing the likelihood of confounding [18, 19, 21]
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