Out-of-Pocket Healthcare Expenditures Associated with Prescription Opioid Use in Older Adults with Non-cancer Chronic Pain.

Abstract

Introduction: Chronic pain is a long-term illness impacting quality of life in older adults, and while opioids are frequently used to manage chronic pain in all adults, there is increased risk of medical complications in older adults stemming from opioid therapy. Therefore, we aimed to examine the relationship of prescription opioids on out-of-pocket (OOP) healthcare expenditures in a cohort of older adults (≥ 50 years) with chronic pain in the United States (US).

Methods: Our analysis used data from the Health and Retirement Study, a longitudinal cohort study capturing health and lifestyle information of older adults living in the US. We employed multivariable Poisson regression with fixed effects to model how OOP expenditures change when older adults start and discontinue opioids.

Results: Our sample had 7295 unique respondents with 20,738 eligible interviews. The median total OOP expenditures were higher in respondents using opioids compared to years when respondents were not (US $396 vs $308; p = 0.001). On fixed-effects Poisson regression analysis, prescription opioid use was associated with higher OOP expenditures for hospitalizations (p < 0.001), doctor/clinic visits (p < 0.001), and nursing home care (p < 0.001), but not total OOP expenditures (p = 0.314).

Conclusions: Prescription opioid use is associated with increased OOP expenditures relating to inpatient, outpatient, and long-term care, suggesting that prescription opioids may not directly translate to increased prescription expenditures but indicate a period of increased healthcare vulnerability for older adults.