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Drivers of excess costs of opioid abuse among a commercially insured population.
Am J Manag Care. 2017 May; 23(5):276-282.AJ

Abstract

OBJECTIVES

To replicate and extend a recently published analysis of the drivers of excess costs of opioid abuse.

STUDY DESIGN

Retrospective data analysis using de-identified claims data from the Truven MarketScan Commercial Claims and Encounter database.

METHODS

Medical and prescription drug claims from beneficiaries covered by large self-insured US companies were used to select patients with incident diagnoses of opioid abuse between 2012 and 2015. Two cohorts, abusers and nonabusers, were matched using propensity score methods. Excess healthcare costs were estimated over a 6-month baseline period and 12-month follow-up period. Cost drivers were assessed by diagnosis (3-digit International Classification of Diseases, Ninth Revision, Clinical Modification groupings) and place of service.

RESULTS

The analysis included 73,714 matched pairs of abusers and nonabusers. Relative to nonabusers, abusers had considerably higher annual healthcare costs of $10,989 per patient, or $1.98 per member per month. Excess costs were similar, yet lower, than the previous analysis using another commercial claims database. In both analyses, a ramp-up in excess costs was observed prior to the incident abuse diagnosis, followed by a decline post diagnosis, although not to baseline levels. Key drivers of excess costs in the 2 studies included opioid use disorders, nonopioid substance misuse, and painful and mental health conditions. From 2010 to 2014, the prevalence of diagnosed opioid abuse doubled, with incidence rates exhibiting an increasing, though flatter, trend than earlier in the period.

CONCLUSIONS

Opioid abuse imposes a considerable economic burden on payers. Many abusers have complex healthcare needs and may require care beyond that which is required to treat opioid abuse. These results are robust and consistent across different data sources.

Authors+Show Affiliations

Analysis Group, Inc, 111 Huntington Ave, 14th Floor, Boston, MA 02199. E-mail: lauren.scarpati@analysisgroup.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28738684

Citation

Scarpati, Lauren M., et al. "Drivers of Excess Costs of Opioid Abuse Among a Commercially Insured Population." The American Journal of Managed Care, vol. 23, no. 5, 2017, pp. 276-282.
Scarpati LM, Kirson NY, Zichlin ML, et al. Drivers of excess costs of opioid abuse among a commercially insured population. Am J Manag Care. 2017;23(5):276-282.
Scarpati, L. M., Kirson, N. Y., Zichlin, M. L., Jia, Z. B., Birnbaum, H. G., & Howard, J. C. (2017). Drivers of excess costs of opioid abuse among a commercially insured population. The American Journal of Managed Care, 23(5), 276-282.
Scarpati LM, et al. Drivers of Excess Costs of Opioid Abuse Among a Commercially Insured Population. Am J Manag Care. 2017;23(5):276-282. PubMed PMID: 28738684.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Drivers of excess costs of opioid abuse among a commercially insured population. AU - Scarpati,Lauren M, AU - Kirson,Noam Y, AU - Zichlin,Miriam L, AU - Jia,Zitong B, AU - Birnbaum,Howard G, AU - Howard,Jaren C, PY - 2017/7/26/entrez PY - 2017/7/26/pubmed PY - 2018/4/26/medline SP - 276 EP - 282 JF - The American journal of managed care JO - Am J Manag Care VL - 23 IS - 5 N2 - OBJECTIVES: To replicate and extend a recently published analysis of the drivers of excess costs of opioid abuse. STUDY DESIGN: Retrospective data analysis using de-identified claims data from the Truven MarketScan Commercial Claims and Encounter database. METHODS: Medical and prescription drug claims from beneficiaries covered by large self-insured US companies were used to select patients with incident diagnoses of opioid abuse between 2012 and 2015. Two cohorts, abusers and nonabusers, were matched using propensity score methods. Excess healthcare costs were estimated over a 6-month baseline period and 12-month follow-up period. Cost drivers were assessed by diagnosis (3-digit International Classification of Diseases, Ninth Revision, Clinical Modification groupings) and place of service. RESULTS: The analysis included 73,714 matched pairs of abusers and nonabusers. Relative to nonabusers, abusers had considerably higher annual healthcare costs of $10,989 per patient, or $1.98 per member per month. Excess costs were similar, yet lower, than the previous analysis using another commercial claims database. In both analyses, a ramp-up in excess costs was observed prior to the incident abuse diagnosis, followed by a decline post diagnosis, although not to baseline levels. Key drivers of excess costs in the 2 studies included opioid use disorders, nonopioid substance misuse, and painful and mental health conditions. From 2010 to 2014, the prevalence of diagnosed opioid abuse doubled, with incidence rates exhibiting an increasing, though flatter, trend than earlier in the period. CONCLUSIONS: Opioid abuse imposes a considerable economic burden on payers. Many abusers have complex healthcare needs and may require care beyond that which is required to treat opioid abuse. These results are robust and consistent across different data sources. SN - 1936-2692 UR - https://www.unboundmedicine.com/medline/citation/28738684/Drivers_of_excess_costs_of_opioid_abuse_among_a_commercially_insured_population_ L2 - https://www.ajmc.com/pubMed.php?pii=87077 DB - PRIME DP - Unbound Medicine ER -