U.S. Department of Veterans Affairs, Veterans Health Administration, Washington, DC, USA.
UCSD Skaggs School of Pharmacy & Pharmaceutical Sciences, 9500 Gilman Drive, MC 0657, La Jolla, CA, 92093-0657, USA.
Subst Abuse Treat Prev Policy. 2021 Oct 20;16(1):80. doi: 10.1186/s13011-021-00415-5.
Previous reports on healthcare costs and expenditures associated with populations prescribed an opioid primarily focused on populations who chronically use opioids or have opioid use disorder. However, studies that characterize the healthcare and expenditures costs among the wider number of people prescribed opioids in a nationally representative population are unavailable. We sought to characterize the healthcare costs and expenditures associated with a population prescribed an opioid in the U.S. from 2008 to 2017.
A serial cross-sectional design was used to compare the economic burden of adult household respondents who were prescribed and not prescribed an opioid using pooled data from the Medical Expenditure Panel Survey (MEPS) between 2008 and 2017. Respondents with an opioid prescription were matched to respondents without an opioid prescription using propensity score match methods with survey weights. Two-part generalized linear models were used to estimate the survey-weighted annual healthcare expenditures and resource utilization adjusting for multiple covariates. Additionally, 10-year trend comparisons between the groups were performed. Costs were adjusted to 2019 US dollars.
There was a weighted total of 31,696,671 respondents with an opioid and 31,536,639 respondents without an opioid after propensity score matching. The sample had a mean (SD) age of 50.63 years (18.03), 58.9% females, and 81.6% Whites. Total annual economic burden among RPOs was $524 billion. Annual total expenditures per respondent with and without an opioid were $16,542 and $7067, respectively (P < 0.001). Similarly, adjusted prescription, outpatient, emergency department, and inpatient expenditures were significantly higher for respondents with an opioid compared to respondents without an opioid. Average annual increases in expenditures were significantly greater among respondents with an opioid compared to respondents without an opioid for total (+$185; 95% CI: $37-$334) and prescription (+$78; 95% CI: $28-$128) expenditures. There were no differences in the average annual trends for outpatient, emergency department, and inpatient expenditures between respondents with and without an opioid.
Respondents with an opioid prescription had higher healthcare expenditures and resource utilization compared to respondents without an opioid prescription from 2008 to 2017. Specifically, significant annual increases were observed for total and prescription expenditures. Additionally, 10-year trends in total and prescription expenditures were higher among respondents with an opioid than respondents without an opioid.
以前关于医疗保健成本和与开处阿片类药物相关的支出的报告主要集中在慢性使用阿片类药物或有阿片类药物使用障碍的人群上。然而，在具有代表性的全国性人群中，描述更多开处阿片类药物的人群的医疗保健和支出成本的研究尚不可用。我们旨在描述美国从 2008 年到 2017 年期间开处阿片类药物的人群的医疗保健成本和支出。
采用序列横截面设计，比较了 2008 年至 2017 年期间使用医疗支出面板调查（MEPS）汇总数据的开处和未开处阿片类药物的成年家庭受访者的经济负担。使用倾向评分匹配方法，根据调查权重，将有阿片类药物处方的受访者与没有阿片类药物处方的受访者进行匹配。使用两部分广义线性模型来估计调整多种协变量后的调查加权年度医疗保健支出和资源利用情况。此外，还对两组之间的 10 年趋势进行了比较。成本已调整为 2019 年美元。
在倾向评分匹配后，共有 31696671 名有阿片类药物处方的受访者和 31536639 名无阿片类药物处方的受访者，加权总计。样本的平均（SD）年龄为 50.63 岁（18.03），女性占 58.9%，白人占 81.6%。RPO 总年度经济负担为 5240 亿美元。有和没有阿片类药物处方的受访者的年人均总支出分别为 16542 美元和 7067 美元（P<0.001）。同样，与没有阿片类药物处方的受访者相比，有阿片类药物处方的受访者的调整后处方、门诊、急诊和住院支出显著更高。与没有阿片类药物处方的受访者相比，有阿片类药物处方的受访者的总支出（+185 美元；95%CI：37-334）和处方支出（+78 美元；95%CI：28-128）的年平均增幅显著更高。有和没有阿片类药物处方的受访者的门诊、急诊和住院支出的年平均趋势没有差异。
从 2008 年到 2017 年，有阿片类药物处方的受访者的医疗保健支出和资源利用高于没有阿片类药物处方的受访者。具体而言，总支出和处方支出均出现显著的年度增长。此外，有阿片类药物处方的受访者的总支出和处方支出的 10 年趋势高于没有阿片类药物处方的受访者。
