1 Pfizer, Durham, North Carolina.
2 Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City.
J Manag Care Spec Pharm. 2019 Jan;25(1):18-27. doi: 10.18553/jmcp.2019.25.1.018.
Reliance on prescription opioids to manage pain has been associated with increases in diversion, overdose, and addiction. Prevalence of misuse and abuse has been shown to be higher among government-insured populations than commercially insured populations. However, the prevalence and costs of misuse/abuse among the Medicare fee-for-service (FFS) population has not been studied.
To (a) determine the prevalence and costs of prescription opioid misuse/abuse and (b) evaluate the prevalence and costs associated with those identified as at risk for opioid misuse/abuse in Medicare FFS beneficiaries.
This retrospective case-control study used Medicare claims data for the calendar years of 2010 and 2011 and included Medicare beneficiaries aged at least 18 years. The index date was the date of first diagnosed misuse/abuse or at risk for abuse and had to occur between July 1, 2010, and June 30, 2011, and beneficiaries had to have at least 6 months continuous eligibility before and after the index date. Matching (1:1) was used for comparing opioid misusers/abusers with nonabuser controls, as well as comparing patients at risk for opioid abuse with controls not at risk for abuse. Controls were matched to cases by gender, age, disability, and geographic region. The index date of the control patient was set equal to the index date of the matched case.
Prevalence of misuse/abuse in the Medicare FFS population was 13.1 per 1,000 persons, with the majority among patients receiving Medicare based on disability (76.2%). The prevalence of at risk for misuse/abuse was 117.4 per 1,000 persons. Approximately half of the Medicare FFS patients used an opioid. Overall total annual unadjusted mean costs of health care resources were significantly greater for abusers than for matched controls ($46,194 vs. $21,964; P < 0.0001), with a mean annual excess cost of $24,230. The overall total adjusted 6-month post-index mean costs of health care resources for abusers was significantly greater than that of matched controls ($33,942 vs. $10,754; P < 0.0001), with a mean excess cost of $23,188.
The prevalence of diagnosed abuse among Medicare FFS population (13.1 per 1,000 persons) was higher than other payer groups studied using similar ICD-9-CM codes, and the majority of abuse was among those receiving Medicare based on disability (76.2%). The prevalence of at-risk abuse was 9 times higher than the prevalence of diagnosed abuse. As with other studies, health care resource utilization and costs were significantly greater for diagnosed abuse than matched controls.
This study was sponsored by Pfizer. Roland is a Pfizer employee and stockholder and was involved in all aspects of the study as part of a mid-career fellowship in pharmacoeconomics with the University of Utah. Ye and Stevens are employees of University of Utah, and Oderda was an employee of University of Utah, which received financial support from Pfizer in connection with the development of this manuscript. Oderda also reports consulting fees from Pfizer, Trevena, and Pacira, unrelated to this study. The results of this study were presented at the Academy of Managed Care Pharmacy Nexus 2015; October 26-29, 2015; Orlando, FL, and the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016; April 19-22, 2016; San Francisco, CA.
依赖处方类阿片药物来控制疼痛与药物滥用、过量用药和成瘾的发生率增加有关。政府保险人群的滥用和误用发生率高于商业保险人群。然而，医疗保险按服务收费（FFS）人群中滥用/误用的流行率和成本尚未研究。
（a）确定处方类阿片药物滥用/误用的流行率和成本；（b）评估医疗保险 FFS 受益人群中与滥用/误用风险相关的流行率和成本。
本回顾性病例对照研究使用了 2010 年和 2011 年的医疗保险索赔数据，包括至少 18 岁的医疗保险受益人。索引日期是首次诊断为滥用/误用或滥用风险的日期，必须在 2010 年 7 月 1 日至 2011 年 6 月 30 日之间，并且受益人在索引日期之前和之后必须至少有 6 个月的连续资格。为了比较阿片类药物滥用者/误用者与非滥用者对照，以及比较滥用风险患者与无滥用风险的对照，使用了 1:1 的匹配（match）。对照患者的索引日期与匹配病例的索引日期相同。
医疗保险 FFS 人群中滥用/误用的流行率为每 1000 人中有 13.1 人，其中大多数患者是基于残疾领取医疗保险（76.2%）。滥用风险的流行率为每 1000 人中有 117.4 人。大约一半的医疗保险 FFS 患者使用了阿片类药物。未调整的年度总医疗资源使用的平均成本，滥用者显著高于匹配对照者（$46,194 比 $21,964；P<0.0001），平均每年超额费用为 $24,230。滥用者调整后 6 个月的年度总医疗资源使用的平均成本显著高于匹配对照者（$33,942 比 $10,754；P<0.0001），平均超额费用为 $23,188。
医疗保险 FFS 人群中诊断出的滥用发生率（每 1000 人中有 13.1 人）高于其他使用类似 ICD-9-CM 编码的支付方群体，而且大多数滥用发生在基于残疾领取医疗保险的人群（76.2%）。滥用风险的流行率是诊断性滥用流行率的 9 倍。与其他研究一样，与匹配对照相比，滥用者的医疗资源利用和成本显著更高。
本研究由辉瑞公司赞助。Roland 是辉瑞公司的员工和股东，作为犹他大学药理学职业生涯中期奖学金的一部分，他参与了研究的各个方面。Ye 和 Stevens 是犹他大学的员工，Oderda 是犹他大学的员工，他在辉瑞公司的支持下参与了这份手稿的开发。Oderda 还报告了辉瑞、Trevena 和 Pacira 的咨询费，与本研究无关。本研究结果在 2015 年管理式医疗药房协会 Nexus 大会上进行了介绍；2015 年 10 月 26-29 日；佛罗里达州奥兰多；以及 2016 年 AMCP 管理式医疗和专科药房年会；2016 年 4 月 19-22 日；加利福尼亚州旧金山。
