Assessment of Annual Cost of Substance Use Disorder in US Hospitals

Abstract

IMPORTANCE A persistently high US drug overdose death toll and increasing health care use associated with substance use disorder (SUD) create urgency for comprehensive estimates of attributable direct costs, which can assist in identifying cost-effective ways to prevent SUD and help people to receive effective treatment. OBJECTIVE To estimate the annual attributable medical cost of SUD in US hospitals from the health care payer perspective. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation of observational data used multivariable regression analysis and mathematical modeling of hospital encounter costs, controlling for patient demographic, clinical, and insurance characteristics, and compared encounters with and without secondary SUD diagnosis to statistically identify the total attributable cost of SUD. Nationally representative hospital emergency department (ED) and inpatient encounters from the 2017 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample were studied. Statistical analysis was performed from March to June 2020.

National Prevalence of Alcohol and Other Substance Use Disorders Among Emergency Department Visits and Hospitalizations: NHAMCS 2014–2018

“…Our estimated 9.4% prevalence of AUD/SUD among ED visits is higher than a recent study’s estimate of 4% using HCUP-NEDS data from 2017. 13 This discrepancy is potentially attributed to differences in measuring SUD in NHAMCS compared to HCUP-NEDS, as our 4% estimate of AUD among ED visits is the same as another study using HCUP-NEDS data from 2013. 6 Our study is the first to use nationally representative NHAMCS data with ascertainment of AUD/SUD through comprehensive medical chart review, rather than relying solely on billing diagnosis codes from claims data commonly used in other studies and national datasets.…”

“…14,25 Meanwhile, our estimate of AUD/SUD being associated with 11.9% of hospitalizations is similar to the 10% found in other studies using HCUP-NIS data from 2016 and 2017. 12,13 Single-center studies in urban centers implementing universal screening for potential AUD/SUD have found even higher estimates of 16-21%, suggesting estimates may be even higher in populations at risk for AUD/SUD. 14,16,26 Our estimated prevalence of AUD/SUD among hospital visits was comparable to those of other common coexisting chronic medical conditions, including congestive heart failure (CHF) (15% of hospitalizations).…”

“…National findings from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS) found a 4% prevalence of AUD/SUD among ED visits in 2017, and HCUP National Inpatient Sample (HCUP-NIS) data suggest a 10% prevalence of AUD/SUD among hospitalizations in 2016 and 2017. 12,13 However, these estimates rely exclusively on billing diagnoses to identify individuals with AUD/SUD, which may underestimate the true prevalence of these conditions. 14,15 Acute care providers may be underdiagnosing AUD/SUD if the reasons for visits are not directly related.…”

Opioid, Cocaine and Methamphetamine Overdose Crisis and Deaths in 2021

“…Reversal and connecting individuals to a treatment facility that includes MAT [18] are essential to positive outcomes. A recent study's results suggest that the cost of effective prevention, intervention, and OUD treatment may be substantially offset by reducing the high direct medical cost of SUD hospital care [19].…”

“…Substance use costs to U.S. society are vast and difficult to estimate with precision, including productivity losses, loss of life, trauma to those left behind. Still, a recent study of hospital costs gave us a clue to the enormity of the costs of substance use disorders [19]. Volkow has suggested that evidence-based prevention and treatment interventions can reduce overdose mortality by 40%.…”