Increased Healthcare Utilization and Expenditures Associated With Chronic Opioid Therapy.

Abstract

Objectives: To assess the association of the transition from incident opioid use to incident chronic opioid therapy (COT) with the trajectories of healthcare utilization and expenditures.

Study design: We used a longitudinal, retrospective cohort design, including seven 120-day time periods covering preindex (t₁, t₂, and t₃), index (t₄), and postindex (t₅, t₆, and t₇) periods with data from adults aged 28 to 63 years at the index date, without cancer, and continuously enrolled in a primary commercial insurance plan (N = 20,201).

Methods: Multivariable analyses were performed on utilization (population-averaged [PA] logistic regression), expenditures (PA generalized estimating equations), and expenditure estimates (counterfactual prediction). The data used were from a commercial claims database (10% random sample from the IQVIA Real-World Data Adjudicated Claims - US database) from 2006-2015.

Results: Patients on COT were more likely to use inpatient services (adjusted odds ratio, 1.11; 95% CI, 1.01-1.21) compared with those who did not. Although expenditures peaked during the index period (t₄) for all users, differences in unadjusted average 120-day expenditures between COT and non-COT users were highest in t₄ for total ($4607) and inpatient ($2453) expenditures. COT users had significantly higher total (β = 0.183; P <.01) and inpatient (β = 0.448; P <.001) expenditures.

Conclusions: The period after incident opioid prescription but before transition to COT is an important time for payers to intervene.