Estimating the Costs of Opioid Abuse and Dependence from an Employer Perspective: a Retrospective Analysis Using Administrative Claims Data

Abstract

BackgroundOpioid abuse and dependence is problematic across many age groups, including the working-age population and their dependents. Little is known, however, about the economic costs of opioid abuse/dependence imposed on employers, who pay for a substantial portion of healthcare costs through their contributions to employer-sponsored health insurance and are also affected by indirect costs such as those due to disability and workplace absenteeism.ObjectiveTo provide a comprehensive, current estimate of the economic burden of prescription opioid abuse/dependence to employers.MethodsAdministrative claims from beneficiaries covered by large self-insured companies throughout the USA were used to identify patients, including employees and dependents, who were diagnosed with opioid abuse and/or dependence (‘abusers’) between 2006 and 2012. Healthcare and work-loss costs for abusers were assessed over a 12-month period and compared with those for patients not diagnosed with abuse (‘comparison patients’), using propensity score matching.Results7,658 matched pairs of abusers and comparison patients were analysed. Relative to comparison patients, abusers had significantly higher annual healthcare resource utilization, leading to US$10,627 in per-patient incremental annual healthcare costs. Additionally, abusers had US$1,244 in excess annual work-loss costs. Together, this implies an employer burden for diagnosed abuse of US$1.71 per member per month.ConclusionOpioid abuse/dependence impose a substantial economic burden on employers.

Economic Burden of Prescription Opioid Misuse and Abuse: A Systematic Review

“…A final group of 16 publications were selected for inclusion in the report. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The two primary reasons for exclusion were an abuse treatment focus (15) and lack of cost data (12). A CASP checklist was completed for these 16 publications to assess quality.…”

“…Eight studies directly compared the health care costs of patients who were opioid abusers with those of a control population of patients who were not opioid abusers. 9,12,[15][16][17][18]20,23 In each of these studies, opioid abuse was identified by medical claims submitted with a diagnosis code for opioid abuse, dependence, or poisoning. Pasquale et al 16 and White et al 23 dealt with more than one payer type, including both commercial insurance and Medicaid or Medicare.…”

“…The five studies that examined commercially insured opioid abusers had a mean cost of $22,916 per patient per year and excess costs of $16,058 per patient per year. [16][17][18]20,23 Additional details are shown in Table 3. Costs were evaluated in two studies in general Medicaid patients, 15 23 Six studies presented data on different patient groups or special circumstances that make them difficult to compare with the studies above.…”

Sources of prescription opioids among diagnosed opioid abusers

“…This study built upon a recently published paper on the costs of opioid abuse from an employer perspective 6 . Specifically, we used the same sample of patients, aged 12-64, diagnosed with opioid abuse or dependence ('abusers') as well as a sample of those not diagnosed with opioid abuse or dependence ('non-abusers') from the de-identified OptumHealth Reporting and Insights (OptumHealth) medical and pharmacy claims database, Q1 1999-Q1 2012.…”

“…Patients were required to have continuous eligibility over an 18 month study period surrounding the first abuse diagnosis. Details of the study period and inclusion criteria are described in Rice et al 6 . To estimate the potential extent of diversion, we examined what share of abusers had access to prescription opioids through prescriptions they obtained prior to their index date, defined as the date of their first abuse diagnosis.…”