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Health Care Burden Associated with Outpatient Opioid Use Following Inpatient or Outpatient Surgery.
J Manag Care Spec Pharm. 2019 Sep; 25(9):973-983.JM

Abstract

BACKGROUND

The treatment of postsurgical pain with prescription opioids has been associated with persistent opioid use and increased health care utilization and costs.

OBJECTIVE

To compare the health care burden between opioid-naive adult patients who were prescribed opioids after a major surgery and opioidnaive adult patients who were not prescribed opioids.

METHODS

Administrative claims data from the IBM Watson Health MarketScan Research Databases for 2010-2016 were used. Opioid-naive adult patients who underwent major inpatient or outpatient surgery and who had at least 1 year of continuous enrollment before and after the index surgery date were eligible for inclusion. Cohorts were defined based on an opioid pharmacy claim between 7 days before index surgery and 1 year after index surgery (opioid use during surgery and inpatient use were not available). To ensure an opioid-naive population, patients with opioid claims between 365 and 8 days before surgery were excluded. Acute medical outcomes, opioid utilization, health care utilization, and costs were measured during the post-index period (index surgery hospitalization and day of index outpatient surgery not included). Predicted costs were estimated from multivariable log-linked gamma-generalized linear models.

RESULTS

The final sample consisted of 1,174,905 opioid-naive patients with an inpatient surgery (73% commercial, 20% Medicare, 7% Medicaid) and 2,930,216 opioid-naive patients with an outpatient surgery (74% commercial, 23% Medicare, and 3% Medicaid). Opioid use after discharge was common among all 3 payer types but was less common among Medicare patients (63% inpatient/43% outpatient) than patients with commercial (80% inpatient/75% outpatient) or Medicaid insurance (86% inpatient/81% outpatient). Across all 3 payers, opioid users were younger, were more likely to be female, and had a higher preoperative comorbidity burden than nonopioid users. In unadjusted analyses, opioid users tended to have more hospitalizations, emergency department visits, and pharmacy claims. Adjusted predicted 1-year post-period total health care costs were significantly higher (P< 0.001) for opioid users than nonopioid users for commercial insurance (inpatient: $22,209 vs. $14,439; outpatient: $13,897 vs. $8,825), Medicare (inpatient: $31,721 vs. $26,761; outpatient: $24,529 vs. $15,225), and Medicaid (inpatient: $13,512 vs. $9,204; outpatient: $11,975 vs. $8,212).

CONCLUSIONS

Filling an outpatient opioid prescription (vs. no opioid prescription) in the 1 year after inpatient or outpatient surgery was associated with increased health care utilization and costs across all payers.

DISCLOSURES

Funding for this study was provided by Heron Therapeutics, which participated in analysis and interpretation of data, drafting, reviewing, and approving the publication. All authors contributed to the development of the publication and maintained control over the final content. Brummett is a paid consultant for Heron Therapeutics and Recro Pharma and reports receipt of research funding from MDHHS (Sub K Michigan Open), NIDA (Centralized Pain Opioid Non-Responsiveness R01 DA038261-05), NIH0DHHS-US-16 PAF 07628 (R01 NR017096-05), NIH-DHHS (P50 AR070600-05 CORT), NIH-DHHS-US (K23 DA038718-04), NIH-DHHS-US-16-PAF06270 (R01 HD088712-05), NIH-DHHS-US-17-PAF02680 (R01 DA042859-05), and UM Michigan Genomics Initiative and holding a patent for peripheral perineural dexmedetomidine. Oderda is a paid consultant for Heron Therapeutics. Pawasauskas is a paid consultant to Heron Therapeutics and Mallinckrodt Pharmaceuticals. England and Evans-Shields are employees of Heron Therapeutics. Kong, Lew, Zimmerman, and Henriques are employees of IBM Watson Health, which was compensated by Heron Therapeutics for conducting this research. Portions of this work were presented as a poster at the AMCP Managed Care and Specialty Pharmacy Annual Meeting 2019; March 25-28, 2019; San Diego, CA.

Authors+Show Affiliations

Department of Anesthesiology, University of Michigan Medical School, Ann Arbor.Heron Therapeutics, San Diego, California.Heron Therapeutics, San Diego, California.IBM Watson Health, Cambridge, Massachusetts.IBM Watson Health, Cambridge, Massachusetts.IBM Watson Health, Cambridge, Massachusetts.IBM Watson Health, Cambridge, Massachusetts.University of Rhode Island College of Pharmacy, Kingston.University of Utah College of Pharmacy, Salt Lake City.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

31313621

Citation

Brummett, Chad M., et al. "Health Care Burden Associated With Outpatient Opioid Use Following Inpatient or Outpatient Surgery." Journal of Managed Care & Specialty Pharmacy, vol. 25, no. 9, 2019, pp. 973-983.
Brummett CM, England C, Evans-Shields J, et al. Health Care Burden Associated with Outpatient Opioid Use Following Inpatient or Outpatient Surgery. J Manag Care Spec Pharm. 2019;25(9):973-983.
Brummett, C. M., England, C., Evans-Shields, J., Kong, A. M., Lew, C. R., Henriques, C., Zimmerman, N. M., Pawasauskas, J., & Oderda, G. (2019). Health Care Burden Associated with Outpatient Opioid Use Following Inpatient or Outpatient Surgery. Journal of Managed Care & Specialty Pharmacy, 25(9), 973-983. https://doi.org/10.18553/jmcp.2019.19055
Brummett CM, et al. Health Care Burden Associated With Outpatient Opioid Use Following Inpatient or Outpatient Surgery. J Manag Care Spec Pharm. 2019;25(9):973-983. PubMed PMID: 31313621.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Health Care Burden Associated with Outpatient Opioid Use Following Inpatient or Outpatient Surgery. AU - Brummett,Chad M, AU - England,Christina, AU - Evans-Shields,Jackie, AU - Kong,Amanda M, AU - Lew,Carolyn R, AU - Henriques,Caroline, AU - Zimmerman,Nicole M, AU - Pawasauskas,Jayne, AU - Oderda,Gary, Y1 - 2019/07/17/ PY - 2019/7/18/pubmed PY - 2020/1/30/medline PY - 2019/7/18/entrez SP - 973 EP - 983 JF - Journal of managed care & specialty pharmacy JO - J Manag Care Spec Pharm VL - 25 IS - 9 N2 - BACKGROUND: The treatment of postsurgical pain with prescription opioids has been associated with persistent opioid use and increased health care utilization and costs. OBJECTIVE: To compare the health care burden between opioid-naive adult patients who were prescribed opioids after a major surgery and opioidnaive adult patients who were not prescribed opioids. METHODS: Administrative claims data from the IBM Watson Health MarketScan Research Databases for 2010-2016 were used. Opioid-naive adult patients who underwent major inpatient or outpatient surgery and who had at least 1 year of continuous enrollment before and after the index surgery date were eligible for inclusion. Cohorts were defined based on an opioid pharmacy claim between 7 days before index surgery and 1 year after index surgery (opioid use during surgery and inpatient use were not available). To ensure an opioid-naive population, patients with opioid claims between 365 and 8 days before surgery were excluded. Acute medical outcomes, opioid utilization, health care utilization, and costs were measured during the post-index period (index surgery hospitalization and day of index outpatient surgery not included). Predicted costs were estimated from multivariable log-linked gamma-generalized linear models. RESULTS: The final sample consisted of 1,174,905 opioid-naive patients with an inpatient surgery (73% commercial, 20% Medicare, 7% Medicaid) and 2,930,216 opioid-naive patients with an outpatient surgery (74% commercial, 23% Medicare, and 3% Medicaid). Opioid use after discharge was common among all 3 payer types but was less common among Medicare patients (63% inpatient/43% outpatient) than patients with commercial (80% inpatient/75% outpatient) or Medicaid insurance (86% inpatient/81% outpatient). Across all 3 payers, opioid users were younger, were more likely to be female, and had a higher preoperative comorbidity burden than nonopioid users. In unadjusted analyses, opioid users tended to have more hospitalizations, emergency department visits, and pharmacy claims. Adjusted predicted 1-year post-period total health care costs were significantly higher (P< 0.001) for opioid users than nonopioid users for commercial insurance (inpatient: $22,209 vs. $14,439; outpatient: $13,897 vs. $8,825), Medicare (inpatient: $31,721 vs. $26,761; outpatient: $24,529 vs. $15,225), and Medicaid (inpatient: $13,512 vs. $9,204; outpatient: $11,975 vs. $8,212). CONCLUSIONS: Filling an outpatient opioid prescription (vs. no opioid prescription) in the 1 year after inpatient or outpatient surgery was associated with increased health care utilization and costs across all payers. DISCLOSURES: Funding for this study was provided by Heron Therapeutics, which participated in analysis and interpretation of data, drafting, reviewing, and approving the publication. All authors contributed to the development of the publication and maintained control over the final content. Brummett is a paid consultant for Heron Therapeutics and Recro Pharma and reports receipt of research funding from MDHHS (Sub K Michigan Open), NIDA (Centralized Pain Opioid Non-Responsiveness R01 DA038261-05), NIH0DHHS-US-16 PAF 07628 (R01 NR017096-05), NIH-DHHS (P50 AR070600-05 CORT), NIH-DHHS-US (K23 DA038718-04), NIH-DHHS-US-16-PAF06270 (R01 HD088712-05), NIH-DHHS-US-17-PAF02680 (R01 DA042859-05), and UM Michigan Genomics Initiative and holding a patent for peripheral perineural dexmedetomidine. Oderda is a paid consultant for Heron Therapeutics. Pawasauskas is a paid consultant to Heron Therapeutics and Mallinckrodt Pharmaceuticals. England and Evans-Shields are employees of Heron Therapeutics. Kong, Lew, Zimmerman, and Henriques are employees of IBM Watson Health, which was compensated by Heron Therapeutics for conducting this research. Portions of this work were presented as a poster at the AMCP Managed Care and Specialty Pharmacy Annual Meeting 2019; March 25-28, 2019; San Diego, CA. SN - 2376-1032 UR - https://www.unboundmedicine.com/medline/citation/31313621/Health_Care_Burden_Associated_with_Outpatient_Opioid_Use_Following_Inpatient_or_Outpatient_Surgery_ L2 - https://www.jmcp.org/doi/10.18553/jmcp.2019.19055?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -