1 Analysis Group, Boston, Massachusetts.
2 Purdue Pharma, Stamford, Connecticut.
J Manag Care Spec Pharm. 2017 Apr;23(4):427-445. doi: 10.18553/jmcp.2017.16265. Epub 2016 Dec 30.
Opioid pain relievers can be highly effective in providing relief for patients suffering from pain. At the same time, prescription opioid abuse, dependence, overdose, and poisoning (hereinafter "abuse") have become a national public health concern. Opioid abuse is also costly: previous estimates of the annual excess costs of opioid abuse to payers range from approximately $10,000 to $20,000 per patient.
To (a) provide a comprehensive, current estimate of the economic burden of opioid abuse to commercial payers and (b) explore the drivers of these excess costs of abuse.
Administrative claims from beneficiaries covered by large self-insured companies throughout the United States were used to identify patients diagnosed with opioid abuse, dependence, and overdose/poisoning ("abuse") between 2012 and 2015. Sample selection criteria identified patients most likely to be misusing opioids. Abusers and nonabuser controls were matched using propensity scores. Excess health care costs were assessed over the 18-month study period. Drivers of excess costs were then evaluated by place of service and medical condition (identified as 3-digit ICD-9-CM groupings).
9,342 matched abuser/nonabuser pairs were analyzed. Relative to nonabusers, abusers had significantly higher annual health care resource utilization, leading to $14,810 in per-patient incremental annual health care costs. Excess costs began accumulating 5 months before the formal, incident diagnosis of abuse, driven by alcohol and nonopioid substance abuse. Major drivers of excess costs of abuse included opioid and other substance abuse disorders, mental health conditions, and painful conditions. Many patients had diagnoses for other substance abuse that predated their opioid abuse diagnoses.
Opioid abuse imposes a substantial economic burden on payers and often occurs in the context of other substance abuse. Poly-substance abuse often precedes the diagnosis of opioid abuse.
This study was funded by Purdue Pharma. Mayne is an employee of Purdue Pharma. Kirson, Scarpati, and Birnbaum are employees of Analysis Group, which received funding from Purdue Pharma to conduct this study. Enloe and Dincer were employees of Analysis Group at the time this research was conducted. Study concept and design were contributed by Kirson, Birnbaum, Mayne, and Scarpati, along with Enloe and Dincer. Enloe and Dincer took the lead in data collection, along with Birnbaum and assisted by Kirson and Scarpati. Data interpretation was performed by all the authors. The manuscript was written and revised by Kirson and Scarpati, along with Mayne and Birnbaum.
阿片类止痛药在缓解疼痛方面非常有效。与此同时，处方类阿片滥用、依赖、过量和中毒（以下简称“滥用”）已成为一个全国性的公共卫生关注点。阿片类药物滥用的代价也很高：此前估计，患者每年因阿片类药物滥用而给支付方造成的额外费用约为每位患者 10000 美元至 20000 美元。
（a）全面、当前地估计商业支付方因阿片类药物滥用造成的经济负担；（b）探索造成这些滥用成本过高的原因。
使用来自美国大型自我保险公司覆盖的受益人的管理索赔数据，以确定在 2012 年至 2015 年间被诊断为阿片类药物滥用、依赖和过量/中毒（“滥用”）的患者。样本选择标准确定了最有可能滥用阿片类药物的患者。使用倾向评分对滥用者和非滥用者进行匹配。在 18 个月的研究期间评估了额外的医疗保健费用。然后根据服务地点和医疗状况（确定为 3 位 ICD-9-CM 分组）评估额外费用的驱动因素。
分析了 9342 对匹配的滥用者/非滥用者对。与非滥用者相比，滥用者的年度医疗资源利用率显著更高，导致每位患者每年的医疗保健费用增加 14810 美元。滥用的正式、初始诊断前 5 个月，就开始出现超额费用，原因是酒精和非阿片类物质滥用。滥用超额费用的主要驱动因素包括阿片类药物和其他物质滥用障碍、心理健康状况和疼痛状况。许多患者在阿片类药物滥用诊断之前就有其他物质滥用的诊断。
阿片类药物滥用给支付方带来了巨大的经济负担，而且经常发生在其他物质滥用的背景下。多物质滥用通常先于阿片类药物滥用的诊断。
本研究由普渡制药公司资助。Mayne 是普渡制药公司的员工。Kirson、Scarpati 和 Birnbaum 是 Analysis Group 的员工，Analysis Group 从普渡制药公司获得资金开展这项研究。Enloe 和 Dincer 在开展这项研究时是 Analysis Group 的员工。研究概念和设计由 Kirson、Birnbaum、Mayne 和 Scarpati 提出，并由 Enloe 和 Dincer 参与。Enloe 和 Dincer 与 Birnbaum 一起主导数据收集，并得到 Kirson 和 Scarpati 的协助。数据解释由所有作者共同完成。由 Kirson 和 Scarpati 撰写并修订了手稿，Mayne 和 Birnbaum 也参与其中。
