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Opioid Abuse: A Detailed Examination of Cost Drivers over a 24-Month Follow-up Period.
J Manag Care Spec Pharm. 2017 Nov; 23(11):1110-1115.JM

Abstract

BACKGROUND

Previous work has documented the considerable economic burden associated with opioid abuse, dependence, and overdose/poisoning (hereafter, "abuse"). Recent analyses have provided insights into the trajectory and drivers of the excess costs of abuse both before and after diagnosis, showing the important role of other substance abuse, mental health issues, and painful conditions.

OBJECTIVE

To build on the recently published study by Kirson et al. (2017) and extend its findings by (a) evaluating the trajectory of excess costs of abuse for an additional year after an incident abuse diagnosis and (b) exploring the diagnosis-level drivers of excess costs over time in greater detail.

METHODS

Using administrative medical and pharmacy claims, which included payment amounts, for beneficiaries covered by large self-insured companies throughout the United States, abusers were matched to controls using the same methods as in Kirson et al. Excess health care costs were assessed over a 24-month follow-up period, which comprised the 6 months before the initial abuse diagnosis and the 18 months after. Drivers of excess costs were then evaluated by diagnosis (grouped at the 3-digit ICD-9-CM level).

RESULTS

This study analyzed 9,345 matched pairs of abusers and non-abusers. Similar to the previous study, mean per-patient excess health care costs were found to rise considerably leading up to and shortly after the incident diagnosis of abuse, reaching $15,764 over the first half of the follow-up period. Over the newly extended follow-up period (months 6 to 18 after diagnosis), excess costs remained elevated ($7,346) and did not return to baseline levels. Over time, an increasing share of excess costs was observed for outpatient services and prescription drug use, relative to acute care settings. A detailed examination of cost drivers suggested elevated costs in several clinical categories (e.g., gastrointestinal, respiratory conditions) beyond those previously identified.

CONCLUSIONS

This research finds that the excess medical costs of abuse extend for at least 1 more year than previously documented, reflecting the need for considerable follow-up care over time. The identification of several other clinical categories with elevated excess costs suggests important areas for future research into the interaction of opioid abuse with the management of other conditions.

DISCLOSURES

This study was funded by Purdue Pharma. Howard was an employee of Purdue Pharma at the time that this study was conducted. Kirson, Scarpati, Jia, and Wen are employees of Analysis Group, which received funding from Purdue Pharma to conduct this study. Study concept and design were contributed by Kirson, Scarpati, and Howard, along with Jia and Wen. Jia and Wen took the lead in data collection, with assistance from Scarpati and Kirson. Data interpretation was performed by Scarpati, Kirson, and Howard, with assistance from Jia and Wen. The manuscript was written and revised by Scarpati, Kirson, and Howard.

Authors+Show Affiliations

1 Analysis Group, Boston, Massachusetts.1 Analysis Group, Boston, Massachusetts.1 Analysis Group, Boston, Massachusetts.1 Analysis Group, Boston, Massachusetts.2 Purdue Pharma, Stamford, Connecticut.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29083966

Citation

Scarpati, Lauren M., et al. "Opioid Abuse: a Detailed Examination of Cost Drivers Over a 24-Month Follow-up Period." Journal of Managed Care & Specialty Pharmacy, vol. 23, no. 11, 2017, pp. 1110-1115.
Scarpati LM, Kirson NY, Jia ZB, et al. Opioid Abuse: A Detailed Examination of Cost Drivers over a 24-Month Follow-up Period. J Manag Care Spec Pharm. 2017;23(11):1110-1115.
Scarpati, L. M., Kirson, N. Y., Jia, Z. B., Wen, J., & Howard, J. (2017). Opioid Abuse: A Detailed Examination of Cost Drivers over a 24-Month Follow-up Period. Journal of Managed Care & Specialty Pharmacy, 23(11), 1110-1115. https://doi.org/10.18553/jmcp.2017.17019
Scarpati LM, et al. Opioid Abuse: a Detailed Examination of Cost Drivers Over a 24-Month Follow-up Period. J Manag Care Spec Pharm. 2017;23(11):1110-1115. PubMed PMID: 29083966.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Opioid Abuse: A Detailed Examination of Cost Drivers over a 24-Month Follow-up Period. AU - Scarpati,Lauren M, AU - Kirson,Noam Y, AU - Jia,Zitong B, AU - Wen,Jody, AU - Howard,Jaren, Y1 - 2017/06/06/ PY - 2017/10/31/entrez PY - 2017/10/31/pubmed PY - 2018/6/19/medline SP - 1110 EP - 1115 JF - Journal of managed care & specialty pharmacy JO - J Manag Care Spec Pharm VL - 23 IS - 11 N2 - BACKGROUND: Previous work has documented the considerable economic burden associated with opioid abuse, dependence, and overdose/poisoning (hereafter, "abuse"). Recent analyses have provided insights into the trajectory and drivers of the excess costs of abuse both before and after diagnosis, showing the important role of other substance abuse, mental health issues, and painful conditions. OBJECTIVE: To build on the recently published study by Kirson et al. (2017) and extend its findings by (a) evaluating the trajectory of excess costs of abuse for an additional year after an incident abuse diagnosis and (b) exploring the diagnosis-level drivers of excess costs over time in greater detail. METHODS: Using administrative medical and pharmacy claims, which included payment amounts, for beneficiaries covered by large self-insured companies throughout the United States, abusers were matched to controls using the same methods as in Kirson et al. Excess health care costs were assessed over a 24-month follow-up period, which comprised the 6 months before the initial abuse diagnosis and the 18 months after. Drivers of excess costs were then evaluated by diagnosis (grouped at the 3-digit ICD-9-CM level). RESULTS: This study analyzed 9,345 matched pairs of abusers and non-abusers. Similar to the previous study, mean per-patient excess health care costs were found to rise considerably leading up to and shortly after the incident diagnosis of abuse, reaching $15,764 over the first half of the follow-up period. Over the newly extended follow-up period (months 6 to 18 after diagnosis), excess costs remained elevated ($7,346) and did not return to baseline levels. Over time, an increasing share of excess costs was observed for outpatient services and prescription drug use, relative to acute care settings. A detailed examination of cost drivers suggested elevated costs in several clinical categories (e.g., gastrointestinal, respiratory conditions) beyond those previously identified. CONCLUSIONS: This research finds that the excess medical costs of abuse extend for at least 1 more year than previously documented, reflecting the need for considerable follow-up care over time. The identification of several other clinical categories with elevated excess costs suggests important areas for future research into the interaction of opioid abuse with the management of other conditions. DISCLOSURES: This study was funded by Purdue Pharma. Howard was an employee of Purdue Pharma at the time that this study was conducted. Kirson, Scarpati, Jia, and Wen are employees of Analysis Group, which received funding from Purdue Pharma to conduct this study. Study concept and design were contributed by Kirson, Scarpati, and Howard, along with Jia and Wen. Jia and Wen took the lead in data collection, with assistance from Scarpati and Kirson. Data interpretation was performed by Scarpati, Kirson, and Howard, with assistance from Jia and Wen. The manuscript was written and revised by Scarpati, Kirson, and Howard. SN - 2376-1032 UR - https://www.unboundmedicine.com/medline/citation/29083966/Opioid_Abuse:_A_Detailed_Examination_of_Cost_Drivers_over_a_24_Month_Follow_up_Period_ L2 - https://www.jmcp.org/doi/10.18553/jmcp.2017.17019?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -