Abuse of prescription opioids imposes a substantial economic burden on society. |
While the direct healthcare costs of opioid abuse have been well documented, considerably less research has focused on the indirect costs of abuse, which appear to be substantial. Further research to better quantify the burden of indirect costs of opioid abuse is warranted. |
1 Introduction
2 Methods
2.1 Literature Search and Screen
2.2 Data Extraction/Summary and Quality Assessment
3 Results
3.1 Direct Healthcare Costs
Author, country | Currency (adjusted year) | Direct costs, abusers vs non-abusers | ||||||
---|---|---|---|---|---|---|---|---|
Inpatient | Outpatient | ED | Rehabilitation facility | Pharmacy | Medical | Total | ||
Baser et al. [38], USA | USD (2010) |
Patients prescribed an opioid
US$12,837 vs US$3436; p < 0.0001
Patients without an opioid prescription
US$13,423 vs US$1680; p < 0.0001
Opioid-abuse related
Patients prescribed an opioid
US$9603 vs US$5; p < 0.0001
Patients without an opioid prescription
US$7089 vs US$5; p < 0.0001 |
Patients prescribed an opioid
US$13,062 vs US$7801; p < 0.0001
Patients without an opioid prescription
US$10,723 vs US$3864; p < 0.0001
Opioid-abuse related
Patients prescribed an opioid
US$2272 vs US$2; p < 0.0001
Patients without an opioid prescription
US$2851 vs US$2; p < 0.0001 | NR | NR |
Patients prescribed an opioid
US$2209 vs US$1741; p < 0.0001
Patients without an opioid prescription
US$1229 vs US$593; p < 0.0001
Opioid-abuse related
Patients prescribed an opioid
US$368 vs US$171; p < 0.0001
Patients without an opioid prescription
US$127 vs US$10; p < 0.0001 | NR |
Patients prescribed an opioid
US$28,882 vs US$13,605; p < 0.0001
Patients without an opioid prescription
US$25,197 vs US$6350; p < 0.0001
Opioid-abuse related
Patients prescribed an opioid
US$8956 vs US$218; p < 0.0001
Patients without an opioid prescription
US$8733 vs US$20; p < 0.0001 |
Cochran et al. [35], USA | USD (NR) | NR | NR | NR | NR |
Prescription drug copayment
OUD: US$8.69 (9.70); p < 0.0001 Non-OUD: US$5.84 (5.13) | NR | NR |
Electricwala et al. [60], USA | USD (NR) | NR | NR | NR | NR | NR |
Incremental direct medical costs associated with opioid overdose, PPPY
Prescription opioid users vs non-medical users: US$65,277 vs US$41,102; p < 0.05
Overdose-specific costs, PPPY
Prescription opioid users vs non-medical users: US$12,111 vs US$11,070a | NR |
Howard et al. [17], USA | USD (2015) | NR | NR | NR | NR | NR | NR |
1-year healthcare costs
Opioid abusers: US$28,717 Matched controls: US$13,907 Difference: US$14,810 |
Howard et al. [23], USA | USD (2015) |
Proportion of excess healthcare cost of abuse per patient, %
b
Dependence: 21.0 Abuse: 35.1 Overdose/poisoning: 31.3 |
Proportion of excess healthcare cost of abuse per patient, %
b
Dependence: 34.0 Abuse: 22.6 Overdose/poisoning: 20.7 |
Proportion of excess healthcare cost of abuse per patient, %
b
Dependence: 20.2 Abuse: 35.6 Overdose/poisoning: 38.2 |
Proportion of excess healthcare cost of abuse per patient, %
b
Dependence: 22.4 Abuse: 13.0 Overdose/poisoning: 2.1 | NR | NR |
Annual healthcare costs, dependence
b
US$27,194 vs US$13,922 Difference: US$13,271a
Annual healthcare costs, abuse
b
US$24,314 vs US$12,629 Difference: US$11,686a Annual healthcare costs, overdose/poisoningb US$47,591 vs US$15,425 Difference: US$32,166a |
Howard et al. [22], USA | USD (2015) | Proportion of excess cost of abuse per patient, %; 36 | Proportion of excess cost of abuse per patient, %; 7 | Proportion of excess cost of abuse per patient, %; 10 | Proportion of excess cost of abuse per patient, %; 41 | Proportion of excess cost of abuse per patient, %; 5 | NR |
Annual healthcare costs
US$25,223 vs US$13,753 Difference: US$11,470a |
Johnston et al. [34], USA | USD (2014) |
WC group
c
US$9824 (20,747) vs US$2327 (13,165); p < 0.001
STD group
c
US$14,540 (34,986) vs US$5614 (24,022); p < 0.001 |
Outpatient services healthcare costs
c
WC group
c
US$5236 (6879) vs US$2800 (6964); p < 0.001
STD group
c
US$8720 (10,886) vs US$6256 (9598); p < 0.001
Outpatient physician office visit costs
c
WC group
US$1192 (996) vs US$590 (664); p < 0.001
STD group
US$1480 (1310) vs US$739 (720); p < 0.001 |
WC group
c
US$830 (1780) vs US$217 (673); p < 0.001
STD group
c
US$1238 (3726) vs US$297 (921); p < 0.001 | NR |
WC group
c
US$5302 (6887) vs US$1925 (3893); p < 0.001
STD group
c
US$4871 (6221) vs US$1804 (4116); p < 0.001 |
WC group
c
US$17,082 (23,813) vs US$5933 (16,582); p < 0.001
STD group
c
US$25,978 (40,788) vs US$12,907 (27,709); p < 0.001 |
WC group
c
US$22,384 (25,934) vs US$7859 (17,639); p < 0.001
STD group
c
US$30,849 (42,009) vs US$14,711 (28,541); p < 0.001
Median total all-cause healthcare costs
c
WC group
US$14,038 vs US$3150a
STD group
US$18,185 vs US$7077a |
Kirson et al. [18], USA | USD (2015) |
Pre-index
d
US$2647 (18,339) vs US$1918 (17,375) Difference: US$729a |
Pre-index
d
US$3728 (10,267) vs US$3144 (10,393) Difference: US$584a |
Pre-index
d
US$2401 (12,895) vs US$969 (6085) Difference: US$1431a |
Pre-index
d
US$345 (3380) vs US$71 (1350) Difference: US$274a |
Pre-index
d
US$1511 (6234) vs US$1445 (4934) Difference: US$66a | NR |
Pre-index
d
US$10,632 (30,743) vs US$7548 (25,798) Difference: US$3084a |
Post-index
e
US$4235 (18,278) vs US$1355 (12,439) Difference: US$2880a |
Post-index
e
US$6692 (15,261) vs US$2786 (11,512) Difference: US$3906a |
Post-index
e
US$3141 (12,962) vs US$835 (5610) Difference: US$2306a |
Post-index
e
US$2369 (9871) vs US$45 (966) Difference: US$2324a |
Post-index
e
US$1649 (5510) vs US$1339 (4820) Difference: US$310a |
Post-index
e
US$18,086 (34,131) vs US$6359 (21,848) Difference: US$11,726a | |||
Scarpati et al. [21], USA | USD (2015) |
Pre-index
d
US$3491 (22,083) vs US$2020 (17,115) Difference: US$1471; p < 0.01 |
Pre-index
d
US$3271 (10,503) vs US$2900 (10,577) Difference: US$371; p < 0.01 |
Pre-index
d
US$1007 (5822) vs US$477 (3098) Difference: US$531; p < 0.01 |
Pre-index
d
US$579 (5132) vs US$77 (1799) Difference: US$503; p < 0.01 |
Pre-index
d
US$1554 (5996) vs US$1412 (5280) Difference: US$143; p < 0.01 |
Pre-index
d
US$8349 (28,173) vs US$5474 (22,584) Difference: US$2875; p < 0.01 |
Pre-index
d
US$9903 (29,390) vs US$6885 (23,972) Difference: US$3018; p < 0.01 |
Post-index
e
US$4877 (29,216) vs US$2448 (21,069) Difference: US$2429; p < 0.01 |
Post-index
e
US$3180 (9637) vs US$2895 (9768) Difference: US$284; p < 0.01 |
Post-index
e
US$1149 (4048) vs US$539 (2657) Difference: US$610; p < 0.01 |
Post-index
e
US$4281 (14,808) vs US$66 (1566) Difference: US$4215; p < 0.01 |
Post-index
e
US$1679 (5269) vs US$1247 (4518) Difference: US$432; p < 0.01 |
Post-index
e
US$13,486 (35,909) vs US$5947 (25,241) Difference: US$7539; p < 0.01 |
Post-index
e
US$15,165 (36,658) vs US$7194 (26,171) Difference: US$7971; p < 0.01 | ||
Scarpati et al. [25], USA | USD (2015) |
Proportion of excess costs, %
6 months pre-index: 28 6 months post-index: “remained relatively stable” 6–12 months post-index: 16 12–18 months post-index: 20 |
Proportion of excess costs, %
6 months pre-index: 20 6 months post-index: 33 6–12 months post-index: 41 12–18 months post-index: 42 |
Proportion of excess costs, %
6 months pre-index: 40 6 months post-index: 19 6–12 months post-index: 21 12–18 months post-index: 16 |
Proportion of excess costs, %
6 months pre-index: 7 6 months post-index: 19 6–12 months post-index: 14 12–18 months post-index: 13 |
Proportion of excess costs, %
6 months pre-index: 6 6 months post-index: “remained relatively stable” 6–12 months post-index: 9 12–18 months post-index: 8 |
Total excess medical costs
− 6 to 0 months: US$3329 (26,214) 0 to 6 months: US$11,771 (26,904) 6 to 12 months: US$3985 (24,367) 12 to 18 months: US$2719 (16,953) All p < 0.001 |
Incremental cost of opioid abuse
− 6 to 6 months: US$15,764 6–18 months: US$7346 |
Pasquale et al. [24], USA | USD (2010) | NRf | NRf | NRf | NRf | NRf | NRf |
Post-index period
g
Commercial
US$25,469 vs US$5536 Difference: US$19,333; p < 0.0001
Medicare < 65
US$18,438 vs US$12,294 Difference: US$6145; p < 0.0001
Medicare ≥ 65
US$11,438 vs US$9613 Difference: US$1825 p < 0.0001
Abuse-related, post-index period
g
Commercial: US$2099 Medicare < 65: US$539 Medicare ≥ 65: US$170 |
Rice et al. [19], USA | USD (2012) | US$5843 (25,952) vs US$2345 (18,932) Difference: US$3498 Ratio: 2.5; p < 0.001 | US$5465 (10,532) vs US$3997 (11,483) Difference: US$1467 Ratio: 1.4; p < 0.001 | US$3163 (9880) vs US$871 (5232) Difference: US$2291 Ratio: 3.6; p < 0.001 | US$1821 (5904) vs US$49 (825) Difference: US$1772 Ratio: 36.9; p < 0.001 | US$2826 (5169) vs US$2045 (4287) Difference: US$781 Ratio: 1.4; p < 0.001 | US$17,518 (35,488) vs US$7671 (25,639) Difference: US$9847 Ratio: 2.3; p < 0.001 | US$20,343 (36,498) vs US$9716 (26,676) Difference: US$10,627 Ratio: 2.1; p < 0.001 |
Rice et al. [20], USA | USD (2012) | US$10,011 (41,249) vs US$3212 (23,465) Difference: US$6798; p < 0.001 | US$7386 (14,882) vs US$4603 (12,582) Difference: US$2784; p < 0.001 | US$1885 (5047) vs US$616 (2444) Difference: US$1269; p < 0.001 | NR | US$3019 (5762) vs US$2494 (6123) Difference: US$525; p < 0.001 | US$19,282 (47,886) vs US$8431 (29,880) Difference: US$10,851; p < 0.001 | US$22,301 (48,876) vs US$10,925 (31,363) Difference: US$11,376; p < 0.001 |
Howard et al. [26], USA | USD (2012) | Proportion of excess cost of abuse per patient, %h; 36 | Proportion of excess cost of abuse per patient, %h; 41 | Proportion of excess cost of abuse per patient, %h; 23 | NR | NR |
Total medical costs
US$17,518 vs US$7671 Difference: US$9847a | NR |
Roland et al. [37], USA | USD (NAi) | Pre-index periodd,j US$712 (3552.7) vs US$85 (1007.6); p < 0.0001 Post-index periodj,k US$881 (3831.0) vs US$101 (1090.6); p < 0.0001 DID: 152; p < 0.0001
Abuse-related
Pre-index periodd,j Abusers: US$89 (1027.7) Post-index periodj,k Abusers: US$301 (955.4) DID: 212; p < 0.0001 | Pre-index periodd,j US$777 (1548.9) vs US$205 (715.4); p < 0.0001 Post-index periodj,k US$860 (1447.2) vs US$221 (663.6); p < 0.0001 DID: 67; p < 0.0001
Abuse-related
Pre-index periodd,j Abusers: US$26 (180.5) Post-index periodj,k Abusers: US$116 (262.7) DID: 90; p < 0.0001 | Pre-index periodd,j US$126 (416.3) vs US$13 (98.3); p < 0.0001 Post-index periodj,k US$129 (396.3) vs US$15 (84.1); p < 0.0001 DID: 2; p < 0.0001 | NR |
Costs for all prescriptions filled (all non-opioid and opioid)
Pre-index periodd,j US$367 (764.9) vs US$82 (289.6); p < 0.0001 Post-index periodj,k US$398 (736.5) vs US$87 (263.0); p < 0.0001 DID: 26; p < 0.0001
Costs for opioid prescriptions filled
l
Pre-index periodd,j US$146 (613.0) vs US$3 (57.8); p < 0.0001 Post-index periodj,k US$161 (570.3) vs US$3 (40.5); p < 0.0001 DID: 16; p < 0.001 | NR | Pre-index periodd,j US$1856 (4446.1) vs US$372 (1406.3); p < 0.0001 Difference: US$1484 Post-index periodj,k US$2138 (4577.3) vs US$408 (1556.8); p < 0.0001 Difference: US$1730 DID: 245; p < 0.0001 |
Rossiter et al. [61], USA | USD (2011) | NR | NR | NR | NR |
Commercially insured patients
US$11,230 (13,784) vs US$11,529 (14,155) Difference: − US$299; 95% CI − 1060 to 461; p = 0.440
Medicare-eligible patients
US$10,649 (9387) vs US$12,152 (19,769) Difference: − US$1504; 95% CI − 4113 to 1106; p = 0.258
Medicaid patients
US$12,851 (24,320) vs US$12,165 (11,994) Difference: US$686; 95% CI − 1580 to 2953; p = 0.552 |
Commercially insured patients
US$37,846 (53,282) vs US$28,390 (50,575) Difference: US$9456; 95% CI 6648–12,264; p < 0.001
Medicare-eligible patients
US$34,965 (44,885) vs US$24,920 (44,423) Difference: US$10,046; 95% CI 2565–17,527; p = 0.009
Medicaid patients
US$34,607 (44,852) vs US$23,106 (39,096) Difference: US$11,501; 95% CI 6632–16,369; p < 0.001
Annual medical cost savings associated with ERO with abuse-deterrent technology (per patient; total)
Diagnosed abusers
Commercially insured: US$9456; US$34,730,641 Medicare-eligible: US$10,046; US$0 Medicaid: US$11,501; US$15,769,878 Uninsured: US$11,501; US$35,408,151 Sub-total for diagnosed abusers: US$85,908,669
Undiagnosed abusers
Commercially insured: US$7565; US$138,922,564 Medicare-eligible: US$8036; US$0 Medicaid: US$9200; US$63,079,510 Uninsured: US$9200; US$141,632,603 Sub-total for diagnosed abusers: US$343,634,677 Total annual cost savings: US$429,543,346 | NR |
Holly et al. [50], USA | USD (2011) | Proportion of excess cost of abuse per patient, %h; 76 | Proportion of excess cost of abuse per patient, %h; 10 | Proportion of excess cost of abuse per patient, %h; 14 | NR | NR | US$39,753 vs US$31,178 Difference: US$8575a | NR |
3.2 Healthcare Resource Utilization
Author, country | Healthcare resource utilization, abusers vs non-abusers | |||||
---|---|---|---|---|---|---|
Inpatient visits | LOS, inpatient days | Outpatient visits | ED visits | Rehabilitation facility | Pharmacy | |
Baser et al. [38], USA |
Patients prescribed an opioid
a
53.39 vs 17.06; p < 0.0001
Patients without an opioid prescription
a
47.47 vs 10.69; p < 0.0001
Opioid-related
Patients prescribed an opioid
a
35.94 vs 0.15; p < 0.0001
Patients without an opioid prescription
a
32.54 vs 0.05; p < 0.0001 | NR |
Patients prescribed an opioid
a
99.99 vs 99.52; p < 0.0001
Patients without an opioid prescription
a
99.97 vs 97.13; p < 0.0001 |
Patients prescribed an opioid
a
21.5 vs 10.55; p < 0.0001
Patients without an opioid prescription
a
18.5 vs 6.20; p < 0.0001 | NR | NR |
Cochran et al. [35], USA | 0.8 (1.2) vs 0.1 (0.4); p <0.0001b |
Hospitalization days
4.8 (11.1) vs 0.5 (2.6); p <0.0001b | 10.3 (10.5) vs 6.5 (6.8); p <0.0001b | 1.7 (4.0) vs 0.3 (0.8); p <0.0001b OR: 1.04; 95% CI 1.02–1.05 | NR |
Opioid days’ supply
272.5 (367.7) vs 33.2 (104.9); p <0.0001b |
Mental health-related hospitalization days
3.2 (7.2) vs 0.0 (0.7); p <0.0001b OR: 1.02; 95% CI 1.01–1.03 |
Mental health-related
b
9.0 (11.0) vs 0.7 (3.1); p <0.0001b OR: 1.04; 95% CI 1.04–1.05 |
Opioid units dispensed
1082.1 (2,112.3) vs 160.0 (890.1); p <0.0001b | ||||
Mental health-related
0.4 (0.7) vs 0.0 (0.1); p <0.0001b OR: 1.32; 95% CI 1.16–1.50 | ||||||
Johnston et al. [34], USA |
Percent of patients with an inpatient visit
WC group
a
57.7 vs 9.4c; p < 0.001
STD group
a
55.2 vs 16.6; p < 0.001 |
WC group
10.6 (9.2) vs 4.6 (6.9)c; p < 0.001
STD group
10.3 (12.2) vs 5.2 (7.9)c; p < 0.001 |
Percent of patients with an outpatient visit
WC group
a
96.8 vs 86.8c; p < 0.001
STD group
a
98.4 vs 94.8c; p = 0.0012 |
Percent of patients with an ED visit
WC group
a
61.4 vs 31.1c; p < 0.001
STD group
a
66.3 vs 34.8c; p < 0.001 | NR |
Outpatient pharmacy prescriptions
WC group
46.7 (29.0) vs 22.4 (22.1)c; p < 0.001
STD group
47.9 (28.9) vs 20.6 (20.6)c; p < 0.001 |
Inpatient visits
WC group
1.8 (1.3) vs 1.3 (0.7)c; p < 0.001
STD group
1.9 (1.4) vs 1.3 (0.7)c; p < 0.001 |
Office visits
WC group
11.0 (8.2) vs 5.7 (6.1)c; p < 0.001
STD group
13.8 (10.4) vs 7.2 (6.2)c; p < 0.001 |
ED visits
WC group
2.1 (3.2) vs 0.5 (1.2)c; p < 0.001
STD group
2.0 (3.4) vs 0.5 (1.1)c; p < 0.001 | ||||
Outpatient services
WC group
46.3 (49.1) vs 23.4 (33.6)c; p < 0.001
STD group
67.7 (62.4) vs 44.7 (49.9)c; p < 0.001 | ||||||
Pasquale et al. [24], USA |
Pre-index
d
Commercial
243 (26.4) vs 238 (12.9)a RR ratio: 2.0; p < 0.0001
Medicare < 65
1138 (35.9) vs 1848 (29.2)a RR ratio: 1.2; p < 0.0001
Medicare ≥ 65
1320 (30.7) vs 2799 (32.5)a RR ratio: 0.9; p < 0.05 | NR |
Pre-index
d
Commercial
889 (96.5) vs 1729 (93.9)a RR ratio: 1.0 p < 0.005
Medicare < 65
3155 (99.6) vs 6287 (99.2)a RR ratio: 1.0; p < 0.05
Medicare ≥ 65
4298 (99.9) vs 8563 (99.5)a RR ratio: 1.0; p = 0.0 |
Pre-index
d
Commercial
452 (49.1) vs 522 (28.3)a RR ratio: 1.7; p < 0.0001
Medicare < 65
1733 (54.7) vs 2922 (46.1)a RR ratio: 1.2; p < 0.0001
Medicare ≥ 65
1668 (38.3) vs 3362 (39.1)a RR ratio: 1.0; p = 0.70 | NR | NR |
Post-index
e
Commercial
370 (40.2) vs 134 (7.3)a RR ratio: 5.5; p < 0.0001
Medicare < 65
1373 (43.3) vs 1613 (25.5)a RR ratio: 1.7; p < 0.0001
Medicare ≥ 65
1471 (34.2) vs 2154 (25.0)a RR ratio: 1.4; p < 0.0001 |
Post-index
e
Commercial
883 (95.9) vs 1637 (88.9)a RR ratio: 1.1; p < 0.0001
Medicare < 65
3150 (99.4) vs 6241 (98.5)a RR ratio: 1.0; p < 0.0001
Medicare ≥ 65
4295 (99.9) vs 8503 (98.8)a RR ratio: 1.0; p < 0.0001 |
Post-index
e
Commercial
473 (51.4) vs 304 (16.5)a RR ratio: 3.1; p < 0.0001
Medicare < 65
1809 (57.1) vs 2649 (41.8)a RR ratio: 1.4; p < 0.0001
Medicare ≥ 65
1795 (41.7) vs 2816 (32.7)a RR ratio: 1.3; p < 0.0001 | ||||
Rice et al. [19], USA |
See LOS
| 4.5 (11.0) vs 0.9 (5.6) Difference: 3.6 Ratio: 4.9; p < 0.001 | 19.7 (17.3) vs 14.4 (15.6) Difference: 5.3 Ratio: 1.4; p < 0.001 |
ED days
2.5 (4.7) vs 0.8 (2.4) Difference: 1.7 Ratio: 3.1; p < 0.001 |
Rehabilitation facility days
6.5 (19.2) vs 0.2 (2.9) Difference: 6.2 Ratio: 31.2; p < 0.001 |
Prescription fills
31.6 (30.6) vs 22.4 (27.7) Difference: 9.2 Ratio: 1.4; p < 0.001
Unique NDC fills
13.3 (12.8) vs 8.5 (8.8) Difference: 4.8 Ratio: 1.6; p < 0.001 |
Rice et al. [20], USA |
See LOS
| 5.5 (11.7) vs 0.9 (4.6) Difference: 4.7; p < 0.001 | 24.1 (20.8) vs 16.5 (18.7) Difference: 7.7; p < 0.001 |
ED days
1.7 (3.2) vs 0.6 (1.6) Difference: 1.1; p < 0.001 | NR |
Prescription fills
36.0 (32.6) vs 29.2 (33.8) Difference: 6.7; p <0.001
Unique NDC fills
14.2 (11.6) vs 10.1 (9.7) Difference: 4.1; p <0.001 |
Roland et al. [37] USA |
Pre-index
f
0.05 (0.13) vs 0.01 (0.03)g; p < 0.0001
Post-index
h
0.07 (0.12) vs 0.01 (0.03)g; p < 0.0001 DIDi: 0.02; p < 0.0001 |
LOS per hospitalization
Pre-index
f
1.28 (3.81) vs 0.12 (1.00)g; p < 0.0001
Post-index
h
3.06 (5.45) vs 0.23 (1.33)g; p < 0.0001 DIDi: 1.67; p < 0.0001 |
Pre-index
f
2.23 (2.33) vs 0.70 (1.11)g; p < 0.0001
Post-index
h
2.57 (2.34) vs 0.74 (1.10)g; p < 0.0001 DIDi: 0.31; p < 0.0001 |
Pre-index
f
0.18 (0.43) vs 0.02 (0.08)g; p < 0.0001
Post-index
h
0.18 (0.39) vs 0.02 (0.07)g DIDi: 0.00; p < 0.0001 | NR |
Prescription fills
Pre-index
f
3.40 (3.31) vs 0.90 (1.44)g; p < 0.0001
Post-index
h
3.42 (3.10) vs 0.95 (1.44)g DIDi: -0.03; p < 0.0001 |
Abuse-related
Pre-index
f
Abusers: 0.01 (0.04)g
Post-index
h
Abusers: 0.04 (0.06)g DIDi: 0.03; p < 0.0001 |
Abuse-related
Pre-index
f
Abusers: 0.17 (0.74)g
Post-index
h
Abusers: 0.52 (1.08)g DIDi: 0.35; p < 0.0001 |
Opioid prescription fills
Pre-index
f
0.94 (1.12) vs 0.06 (0.23)g; p < 0.0001
Post-index
h
0.86 (0.92) vs 0.06 (0.22)g; p < 0.0001 DIDi: − 0.08; p < 0.001 | ||||
Office visits
Pre-index
f
0.85 (0.87) vs 0.30 (0.40)g; p < 0.0001
Post-index
h
0.86 (0.78) vs 0.31 (0.37)g; p < 0.0001 DIDi: 0.00; p < 0.0001 |
3.2.1 Inpatient Visits and Length of Stay
3.2.2 ED Visits
3.2.3 Pharmacy Utilization
3.3 Indirect Costs
Author, country | Currency (adjusted year) | Indirect costs | |||
---|---|---|---|---|---|
Work loss/absenteeism | Mortality | Productivity | Criminal justice | ||
Florence et al. [27], USA | USD (2013) | NR | NR |
Aggregate costs (millions); % aggregate costs
Reduced productive time/increased disability: US$16,262; 95% CI 13,329–19,195; 20.7 Production lost for incarcerated individuals: US$4180; 95% CI 3957–4556; 5.3 Total lost productivity costs: US$20,441; 95% CI 17,286–23,751; 26.0 Fatal costs, lost productivity: US$21,429; 27.3 |
Aggregate costs (millions); % aggregate costs
Police protection: US$2812; 3.6 Legal and adjudication: US$1288; 1.6 Correctional facilities: US$3218; 4.1 Property lost due to crime: US$335; 0.4 Total criminal justice costs: US$7654; 9.7 |
Inocencio et al. [30], USA | USD (2011) |
Absenteeism costs
Per case: US$618 Total (thousands): US$256,173 | Per case: US$33,664 Total (thousands): US$13,887,512 | Per case: US$34,285 Total (thousands): US$14,143,685 | NR |
Johnston et al. [34], USA | USD (2014) |
Adjusted lost wages associated with work loss
a
WC group; p = 0.5
Abusers: US$13,285 Non-abusers: US$14,963
STD group; p < 0.001
Abusers: US$9718 Non-abusers: US$7661 | NR | NR | NR |
Patel et al. [39], USA | USD (2012) | NR | Productivity costs attributed to opioid poisoning-related mortality: 98.6% | Total productivity costs of pediatric opioid poisonings: US$209.7 million | NR |
Rice et al. [19], US | USD (2012) |
Total work-loss costs
Abusers: US$3773 (6648) Controls: US$2528 (4612) Difference: US$1244 Ratio: 1.5; p < 0.001
Medically related absenteeism costs
Abusers: US$2395 (4305) Controls: US$1655 (2840) Difference: US$739 Ratio: 1.4; p < 0.001 | NR |
Disability costs
Abusers: US$1378 (5347) Controls: US$873 (3600) Difference: US$505 Ratio: 1.6; p = 0.007 | NR |
3.4 Medication-Assisted Treatment
Author, country | Type of opioid abuse | Treatment(s), n | Direct costs | ||||
---|---|---|---|---|---|---|---|
Inpatient | Outpatient | ED | Pharmacy | Total healthcare | |||
Brady et al. [40], USA | Abuse, dependence, overdose/poisoninga |
B-MAT patients
No relapse: 357 Relapse: 120 | US$2254 (13,069) vs US$10,860 (15,941)b; p < 0.001 | US$2562 (10,788) vs US$9964 (23,695)b; p < 0.001 | US$797 (2584) vs US$1436 (2685)b; p < 0.001
Office visits
US$1470 (3395) vs US$2598 (5533)b; p = 0.079 | US$3868 (7244) vs US$2103 (2199)b; p < 0.001 | US$11,000 (21,491) vs US$26,969 (37,669)b; p < 0.001 |
Clark et al. [58], USA | Abuse, dependencea | MassHealth members who received treatment for opioid addiction, 2004–2010: 56,278 Buprenorphine: 18,866 Methadone: 24,309 Non-OAT behavioral health: 31,220 | NR | NR | NR | NR | Methadone and buprenorphine treatment episodes were associated with US$223 to US$153 lower total healthcare expenditures per month than other non-OAT behavioral health treatment episodesc |
Clay et al. [43], USA | Dependenced | Patients using buprenorphine/naloxone film formulation: 2796 Patients using tablet buprenorphine/naloxone formulation: 1510 | Pre-indexe,f Tablet: US$9987; 95% CI 7105–14,038 Film: US$7534; 95% CI 4562–10,392 p = 0.0049 (GLM); p = 0.0040 (logistic model) | Pre-indexe,f Tablet: US$7066; 95% CI 5799–8612 Film: US$6478; 95% CI 5346–7849 p = 0.0485 | Pre-indexe,f Tablet: US$91; 95% CI 63–130 Film: US$66; 95% CI 48–91 p = 0.0842 (GLM); p = 0.1306 (logistic model) | Pre-indexe,f Tablet: US$2546; 95% CI 1988–3260 Film: US$2008; 95% CI 1582–2549 p < 0.0001 | Pre-indexe,f Tablet: US$20,632; 95% CI 16,895–25,195 Film: US$17,772 95% CI 14,644–21,569 p = 0.0008 |
Post-indexf,g Tablet: US$8198; 95% CI 5550–12,111 Film: US$5371; 95% CI 3499–8245 p = 0.0806 (GLM); p = 0.0158 (logistic model) | Post-indexf,g Tablet: US$6668; 95% CI 2685–16,558 Film: US$5507; 95% CI 2217–13,676 p = 0.0104 | Post-indexf,g Tablet: US$79; 95% CI 42–145 Film: US$57; 95% CI 28–112 p = 0.3917 (GLM); p = 0.3852 (logistic model) | Post-indexf,g Tablet: US$4467; 95% CI 2886–6963 Film: US$4028; 95% CI 2586–6275 p = 0.0039 | Post-indexf,g Tablet: US$19,853; 95% CI 4515–87,291 Film: US$14,431; 95% CI 3277–63,532 p < 0.0001 | |||
Khemiri et al. [44], USA | Abuse, dependencea |
Privately insured population
Buprenorphine/naloxone ≤ 15.7 mg/day: 1949 Buprenorphine/naloxone > 15.7 mg/day: 1949 |
Privately insured population
Pre-indexe US$6985 (18,596) vs US$7607 (21,550); p = 0.34 |
Privately insured population
Pre-indexe US$6594 (11,802) vs US$7416 (24,909); p = 0.19 |
Privately insured population
Pre-indexe US$138 (781) vs US$102 (482); p = 0.09 |
Privately insured population
Pre-indexe US$2914 (5983) vs US$3688 (7882); p = 0.001 |
Privately insured population
Pre-indexe US$16,632 (27,083) vs US$18,814 (40,440); p = 0.049 |
Post-index
g
US$9524 (28,920) vs US$7223 (22,077); p = 0.04
|
Post-index
g
US$6246 (9366) vs US$6507 (11,935); p = 0.57
|
Post-index
g
US$169 (1290) vs US$127 (606); p = 0.35
|
Post-index
g
US$5060 (4323) vs US$7435 (4871); p = 0.0001
|
Post-index
g
US$21,001 (34,102) vs US$21,295 (29,101); p = 0.83
| |||
Publicly insured population
Buprenorphine/naloxone ≤ 15 mg/day: 1041 Buprenorphine/naloxone > 15 mg/day: 1041 |
Publicly insured population
Pre-indexh US$1734 (8033) vs US$1983 (9833); p = 0.53 |
Publicly insured population
Pre-indexh US$2567 (4697) vs US$2622 (4049); p = 0.58 |
Publicly insured population
Pre-indexh US$796 (1923.21) vs US$654 (1256.92); p = 0.33 |
Publicly insured population
Pre-indexh US$1243 (2869) vs US$1196 (2450); p = 0.27 |
Publicly insured population
Pre-indexh US$6340 (11,337) vs US$6455 (11,818); p = 0.82 | ||
Post-index
g
US$1595 (7765) vs US$1241 (7362); p = 0.46
|
Post-index
g
US$6076 (8623) vs US$5640 (7176); p = 0.39
|
Post-index
g
US$978 (2251) vs US$915 (1698); p = 0.62
|
Post-index
g
US$5998 (7019) vs US$6817 (4748); p = 0.03
|
Post-index
g
US$14,648 (16,426) vs US$14,614 (12,398); p = 0.97
| |||
Masters et al. [51], USA | Addiction, abuse, misuse, overusea | Cases: 1126 Controls: 10,314 | US$7719 vs US$5378f Difference: US$2341; p = 0.1231 | US$11,360 vs US$8564f Difference: US$2796; p < 0.0001 |
Hospital ambulatory (includes ED) costs
US$4303 vs US$4212f Difference: US$91; p = 0.8336 | US$9696 vs US$10,755f Difference: US$ -1,059; p = 0.4210 |
Year 1
US$38,020 vs US$31,641f; p = 0.0049
Year 2
US$30,312 vs US$28,316f; p = 0.3096
Year 3
US$29,330 vs US$28,348f; p = 0.6066 |
Shah et al. [45], USA | OUDa | PT: 5275 NPT: 5275 | NR | NR | NR | NR |
Total direct medical costs
US$23,003 vs US$25,626; p < 0.01 |
Shah et al. [46], USA | OUDa | ER-naltrexone: 1041 Buprenorphine: 20,566 Methadone: 745 NPT: 6883 | NR | NR | NR | NR |
% change in total costs
ER naltrexone: +5; p = 0.17 Buprenorphine: +43; p < 0.01 Methadone: +47.7; p < 0.01 NPT: +38.3; p < 0.01 |
Tkacz et al. [41], USA | Abuse, dependence, overdose/poisoninga | B-MAT adherent: 146 B-MAT non-adherent: 309 | US$10,982 (4142) vs US$26,470 (3163)i; p < 0.001 | US$9288 (1871) vs US$14,570 (1430)i; p = 0.011 | US$1891 (717) vs US$4439 (547)i; p < 0.001 | US$6156 (269) vs US$3581 (205)i; p < 0.001 | US$28,458 (5376) vs US$49,051 (4108)i; p = 0.001 |
Tkacz et al. [42], USA | Abuse, dependence, overdose/poisoninga | B-MAT adherent: 205 B-MAT non-adherent: 272 | US$2090 (9632) vs US$6175 (16,837)j; p < 0.001 | US$2372 (5831) vs US$5971 (19,658)j; p = 0.004 | US$648 (1804) vs US$1191 (3081)j; p = 0.014 | US$5103 (8889) vs US$2158 (2978)j; p < 0.001 US$4962 (493) vs US$1990 (176)i,k; p < 0.001 | US$11,857 (17,442) vs US$17,399 (32,742)j; p = 0.485 US$9531 (1110) vs US$13,280 (1415)I,k; p = 0.001 |
Author, country | Type of opioid abuse | Treatment(s), n | Healthcare resource utilization, abusers vs non-abusers | ||||
---|---|---|---|---|---|---|---|
Inpatient visits | LOS, days | Outpatient visits | ED visits | Pharmacy | |||
Brady et al. [40], USA | Abuse, dependence, overdose/poisoninga |
B-MAT patients
No relapse: 357 Relapse: 120 | 49 (13.7) vs 88 (73.3)b; p < 0.001 | NR | 7.5 (15.1) vs 21.1 (25.2); p < 0.001
Office visits
12.7 (12.6) vs 16.5 (18.9); p = 0.333 | 107 (30.0) vs 68 (56.7)b; p < 0.001 |
Prescription fills
26.3 (22.4) vs 21.5 (21.0); p = 0.003 |
Clay et al. [43], USA | Dependence | Patients using buprenorphine/naloxone film formulation: 2796 Patients using tablet buprenorphine/naloxone formulation: 1510 |
Mean probability to have ≥ 1 hospitalization
Pre-index
c
Tablet: 0.34; 95% CI 0.30–0.39 Film: 0.3; 95% CI 0.26–0.35; p = 0.004 | NR |
Pre-index
c
Tablet: 8.74; 95% CI 7.96–9.61 Film: 8.93; 95% CI 8.14–9.80; p = 0.2074 |
Mean probability to have ≥ 1 ED visit
Pre-index
c
Tablet: 0.14; 95% CI 0.12–0.15 Film: 0.12; 95% CI 0.11–0.13; p = 0.1306 |
Pharmacy claims
Pre-index
c
Tablet: 28.32; 95% CI 24.37–32.90 Film: 26.76; 95% CI 23.16–30.92; p = 0.0893 |
Post-index
d
Tablet: 0.23; 95% CI 0.20–0.25 Film: 0.19; 95% CI 0.17–0.22; p = 0.0158 |
Post-index
d
Tablet: 9.51; 95% CI 8.60–10.52 Film: 9.88; 95% CI 8.95–10.92; p = 0.0185 |
Post-index
d
Tablet: 0.11; 95% CI 0.09–0.13 Film: 0.1; 95% CI 0.08–0.12; p = 0.3852 |
Post-index
d
Tablet: 33.61; 95% CI 27.65–40.85 Film: 32.71; 95% CI 26.95–39.70; p = 0.2624 | ||||
Khemiri et al. [44], USA | Abuse, dependencea |
Privately insured population
Buprenorphine/naloxone ≤ 15.7 mg/dayb: 1949 Buprenorphine/naloxone > 15.7 mg/dayb: 1949
Publicly insured population
Buprenorphine/naloxone ≤ 15 mg/dayb: 1041 Buprenorphine/naloxone > 15 mg/dayb: 1041 | In the publicly insured population, the probability of psychiatric hospitalization in the year following the treatment initiation was 17% lower in the higher-dose group (p = 0.0214). |
Privately insured population, psychiatric inpatient
Post-index
c
5.9 vs 3.8; p = 0.02 | NS | NS |
Privately insured population, pharmaceutical claims
Pre-index
d
31.8 vs 34.6; p = 0.01
Post-index
c
39.4 vs 43.0; p = 0.01 |
Tkacz et al. [41], USA | Abuse, dependence, overdose/poisoninga | B-MAT adherent: 146 B-MAT non-adherent: 309 | 0.52 (0.26) vs 1.41 (0.20)e; p < 0.001 |
Inpatient
3.7 (1.1) vs 10.0 (0.8)e; p < 0.001 | 27.3 (2.3) vs 30.1 (1.8)e; p = 0.264 | 0.78 (0.22) vs 1.61 (0.17)e; p < 0.001 |
Prescription fills
32.8 (1.4) vs 25.8 (1.0)e; p < 0.001 |
Tkacz et al. [42], USA | Abuse, dependence, overdose/poisoninga | B-MAT adherent: 205 B-MAT non-adherent: 272 | 31 (15.1) vs 106 (39.0)f; p < 0.001 | NR | 8.6 (15.6) vs 12.6 (21.2); p = 0.030
Office visits
15.0 (13.2) vs 12.6 (15.4); p = 0.002 | 61 (29.8) vs 114 (41.9)f; p = 0.006 |
Prescription fills
28.1 (20.4) vs 22.9 (23.1); p < 0.001 |
Shah et al. [45], USA | OUDa | PTb: 5275 NPTb: 5275 | PT vs NPT: 0.5 vs 0.6; p < 0.01 | NR | PT vs NPT: 37.1 vs 42.5; p < 0.01 | “No difference in ED visits across the two cohorts during follow-up period” | NR |
Shah et al. [46], USA | OUDa | ER-naltrexone: 1041 Buprenorphine: 20,566 Methadone: 745 NPT: 6883 |
% change in inpatient visits from baseline to follow-up
ER naltrexone: − 46.6; p < 0.01 Buprenorphine: − 20.8; p < 0.01 Methadone: − 23.2; p = 0.06 NPT: − 15.1; p < 0.01 | NR |
% change in outpatient visits from baseline to follow-up
ER naltrexone: +24.7; p < 0.01 Buprenorphine: +68.1; p < 0.01 Methadone: +195.2; p < 0.01 NPT: +92.8; p < 0.01 |
% change in ED visits from baseline to follow-up
ER naltrexone: − 26.1; p < 0.01 Buprenorphine: − 13.3; p < 0.01 Methadone: − 8.6; p = 0.35 NPT: − 15.5; p < 0.01 | NR |