1 Program in Health Outcomes Research, Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Kingston.
2 Rhode Island Department of Health, Providence.
J Manag Care Spec Pharm. 2018 Mar;24(3):214-224. doi: 10.18553/jmcp.2018.24.3.214.
Overuse and misuse of prescription opioids is associated with increased morbidity and mortality and places a significant cost burden on health systems.
To estimate annual statewide spending for prescription opioids in Rhode Island.
A cross-sectional study of opioids dispensed from retail pharmacies using data from the Rhode Island Prescription Drug Monitoring Program (PDMP) was performed. The study sample consisted of 651,227 opioid prescriptions dispensed to 197,062 patients between January 1, 2015, and December 31, 2015. The mean, median, and total cost of opioid use was estimated using prescription dispensings and patients as units of analysis. A generalized linear model with gamma distribution with an identity link function, and separately with a log link function, was used to estimate the absolute and relative differences in per-patient annual adjusted average opioid prescription cost, respectively, by potential predictors.
The estimated 2015 annual expenditure for opioid prescriptions in Rhode Island was $44,271,827. The average and median costs of an opioid prescription were $67.98 (SD $210.91) and $21.08 (quartile 1 to quartile 3 = $7.65-$47.51), respectively. Prescriptions for branded opioid products accounted for $17,380,279.05, which was approximately 39.3% of overall spending, although only 6% of all opioids dispensed were for branded drugs. On average, patients aged 45-54 years and 55-64 years had overall adjusted spending for opioids that were 1.53 (95% CI = 1.49-1.57) and 1.75 (95% CI = 1.71-1.80) times higher than patients aged 65 years and older, respectively. Per patient Medicaid and Medicare average annual spending for opioid prescriptions were 1.19 (95% CI = 1.16-1.22) and 2.01 (95% CI = 1.96-2.06) times higher than commercial insurance spending, respectively. Annual opioid prescription spending was 2.01 (95% CI = 1.98-2.04) and 1.50 (95% CI = 1.45-1.55) times higher among patients who also had at least 1 dispensing of a benzodiazepine or sympathomimetic stimulant, respectively. Average total spending for prescription opioids per patient increased with the average daily dosage: from 3-fold for patients using 50-90 morphine milligrams equivalent (MME) daily to 22-fold for those receiving 90 or more MME daily compared with those receiving less than 50 MME daily.
This study provides the first estimate of the statewide direct cost burden of prescription opioid use using PDMP data and standardized pricing benchmarks. Total annual cost increased with age up to 65 years, mean daily dose, and concurrent use of benzodiazepines or stimulants. Commercial insurance bore the majority of the cost of prescription opioid use, but cost per patient was highest among Medicare beneficiaries. In addition to reducing harms associated with opioid overuse and misuse, substantial cost savings could be realized by reducing unnecessary opioid use, especially among middle-aged adults.
This study was funded by the Rhode Island Department of Health. Aroke and Kogut report grants from the Rhode Island Department of Health during this study. Kogut is partially supported by Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR). Koziol reports grants from the Centers for Disease Control and Prevention during this study. The other authors have nothing to disclose. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Study concept and design were contributed by Koziol, Ragosta, and Kogut, along with Aroke. Koziol, Ragosta, Aroke, and Kogut collected the data, and data interpretation was performed by Aroke, Buchanan, Wen, and Kogut. The manuscript was primarily written by Aroke, along with Buchanan and Kogut, and revised by Aroke, Buchanan, Wen, and Kogut.
处方类阿片类药物的过度和误用与发病率和死亡率的增加以及医疗系统的巨大成本负担有关。
估计罗得岛州处方类阿片类药物的年度全州支出。
使用来自罗得岛处方药监测计划（PDMP）的数据，对零售药店分发的阿片类药物进行了一项横截面研究。研究样本包括 2015 年 1 月 1 日至 12 月 31 日期间向 197062 名患者开出的 651227 份阿片类药物处方。使用处方分发和患者作为分析单位，估计阿片类药物使用的平均、中位数和总费用。使用具有身份链接函数的伽马分布广义线性模型和对数链接函数分别估计潜在预测因素的每个患者年度调整平均阿片类药物处方费用的绝对和相对差异。
估计罗得岛州 2015 年阿片类药物处方的年度支出为 44271827 美元。阿片类药物处方的平均和中位数费用分别为 67.98 美元（SD 210.91 美元）和 21.08 美元（四分位间距 1 至四分位间距 3=7.65 美元至 47.51 美元）。品牌阿片类药物产品的处方占 17380279.05 美元，约占总支出的 39.3%，尽管所有分发的阿片类药物中只有 6%是品牌药物。平均而言，45-54 岁和 55-64 岁的患者的阿片类药物总支出调整后分别是 65 岁及以上患者的 1.53 倍（95%CI=1.49-1.57）和 1.75 倍（95%CI=1.71-1.80）。每个患者的医疗补助和医疗保险的阿片类药物处方年均支出分别比商业保险高 1.19 倍（95%CI=1.16-1.22）和 2.01 倍（95%CI=1.96-2.06）。与没有使用过苯二氮䓬类药物或拟交感神经刺激剂的患者相比，同时至少有一次使用苯二氮䓬类药物或拟交感神经刺激剂的患者的阿片类药物处方平均总支出分别高出 2.01 倍（95%CI=1.98-2.04）和 1.50 倍（95%CI=1.45-1.55）。每个患者的处方类阿片类药物总支出随平均日剂量增加而增加：与每日使用少于 50 毫克吗啡等效剂量（MME）的患者相比，每日使用 50-90 MME 的患者的支出增加了 3 倍，而每日使用 90 或更多 MME 的患者的支出增加了 22 倍。
本研究使用 PDMP 数据和标准化定价基准，首次估计了全州范围内处方类阿片类药物使用的直接成本负担。总年度成本随年龄增加至 65 岁、平均日剂量和同时使用苯二氮䓬类药物或兴奋剂而增加。商业保险承担了处方类阿片类药物使用的大部分费用，但医疗保险受益人的人均费用最高。除了减少与阿片类药物过度和误用相关的危害外，减少不必要的阿片类药物使用，尤其是在中年人群中，可能会带来巨大的成本节约。
这项研究由罗得岛州卫生部资助。Aroke 和 Kogut 在这项研究期间报告了来自罗得岛州卫生部的拨款。Kogut 部分得到国家过敏和传染病研究所国家卫生研究院机构发展奖号 U54GM115677 的资助，该奖项资助临床和转化研究的推进（Advance-CTR）。Koziol 在这项研究期间报告了来自疾病控制和预防中心的拨款。其他作者没有任何披露。本研究的内容仅由作者负责，不一定代表美国国立卫生研究院的官方观点。Koziol、Ragosta 和 Kogut 提出了概念和设计，Aroke 参与了收集数据，Aroke、Buchanan、Wen 和 Kogut 进行了数据分析。Aroke 主要撰写了手稿，Buchanan 和 Kogut 参与了修订。
