Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Center for Drug Safety and Effectiveness, Johns Hopkins University, Baltimore, MD, USA.
BMC Med. 2018 May 16;16(1):69. doi: 10.1186/s12916-018-1058-y.
Previous studies on high-risk opioid use have only focused on patients diagnosed with an opioid disorder. This study evaluates the impact of various high-risk prescription opioid use groups on healthcare costs and utilization.
This is a retrospective cohort study using QuintilesIMS health plan claims with independent variables from 2012 and outcomes from 2013. We included a population-based sample of 191,405 non-elderly adults with known sex, one or more opioid prescriptions, and continuous enrollment in 2012 and 2013. Three high-risk opioid use groups were identified in 2012 as (1) persons with 100+ morphine milligram equivalents per day for 90+ consecutive days (chronic users); (2) persons with 30+ days of concomitant opioid and benzodiazepine use (concomitant users); and (3) individuals diagnosed with an opioid use disorder. The length of time that a person had been characterized as a high-risk user was measured. Three healthcare costs (total, medical, and pharmacy costs) and four binary utilization indicators (the top 5% total cost users, the top 5% pharmacy cost users, any hospitalization, and any emergency department visit) derived from 2013 were outcomes. We applied a generalized linear model (GLM) with a log-link function and gamma distribution for costs while logistic regression was employed for utilization indicators. We also adopted propensity score weighting to control for the baseline differences between high-risk and non-high-risk opioid users.
Of individuals with one or more opioid prescription, 1.45% were chronic users, 4.81% were concomitant users, and 0.94% were diagnosed as having an opioid use disorder. After adjustment and propensity score weighting, chronic users had statistically significant higher prospective total (40%), medical (3%), and pharmacy (172%) costs. The increases in total, medical, and pharmacy costs associated with concomitant users were 13%, 7%, and 41%, and 28%, 21% and 63% for users with a diagnosed opioid use disorder. Both total and pharmacy costs increased with the length of time characterized as high-risk users, with the increase being statistically significant. Only concomitant users were associated with a higher odds of hospitalization or emergency department use.
Individuals with high-risk prescription opioid use have significantly higher healthcare costs and utilization than their counterparts, especially those with chronic high-dose opioid use.
先前关于高危阿片类药物使用的研究仅关注被诊断为阿片类药物障碍的患者。本研究评估了各种高危处方阿片类药物使用群体对医疗保健成本和利用的影响。
这是一项使用 QuintilesIMS 健康计划索赔数据的回顾性队列研究，其自变量来自 2012 年，结果来自 2013 年。我们纳入了一个基于人群的样本，其中包括 191,405 名非老年成年人，已知性别、一种或多种阿片类药物处方，并在 2012 年和 2013 年连续参保。在 2012 年确定了三个高危阿片类药物使用群体：（1）每天使用 100 毫克以上吗啡等效物连续 90 天以上的患者（慢性使用者）；（2）同时使用阿片类药物和苯二氮䓬类药物 30 天以上的患者（同时使用者）；（3）被诊断为阿片类药物使用障碍的个体。衡量一个人成为高危使用者的时间长短。2013 年的三个医疗保健成本（总费用、医疗费用和药房费用）和四个二进制利用指标（总费用最高的 5%用户、药房费用最高的 5%用户、任何住院治疗和任何急诊就诊）是结果。我们应用了具有对数链接函数和伽马分布的广义线性模型 (GLM) 来计算成本，而逻辑回归则用于利用指标。我们还采用倾向评分加权来控制高危和非高危阿片类药物使用者之间的基线差异。
在有一个或多个阿片类药物处方的人群中，1.45%为慢性使用者，4.81%为同时使用者，0.94%被诊断为阿片类药物使用障碍。在调整和倾向评分加权后，慢性使用者的预期总费用（40%）、医疗费用（3%）和药房费用（172%）均有统计学显著增加。同时使用者的总费用、医疗费用和药房费用分别增加 13%、7%和 41%，而被诊断为阿片类药物使用障碍的患者的总费用、医疗费用和药房费用分别增加 28%、21%和 63%。与高危使用者的时间长短有关的总费用和药房费用均有增加，且具有统计学意义。只有同时使用者与住院或急诊就诊的可能性增加有关。
与对照相比，高危处方阿片类药物使用者的医疗保健成本和利用明显更高，尤其是慢性高剂量阿片类药物使用者。
