Healthcare costs and use before and after opioid overdose in Veterans Health Administration patients with opioid use disorder

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2023-07-19 DOI:10.1111/add.16289

Vilija R. Joyce, Elizabeth M. Oliva, Carla C. Garcia, Jodie Trafton, Steven M. Asch, Todd H. Wagner, Keith Humphreys, Douglas K. Owens, Mark Bounthavong

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Abstract

Aims

To compare healthcare costs and use between United States (US) Veterans Health Administration (VHA) patients with opioid use disorder (OUD) who experienced an opioid overdose (OD cohort) and patients with OUD who did not experience an opioid overdose (non-OD cohort).

Design

This is a retrospective cohort study of administrative and clinical data.

Setting

The largest integrated national health-care system is the US Veterans Health Administration's healthcare systems.

Participants

We included VHA patients diagnosed with OUD from October 1, 2017 through September 30, 2018. We identified the index date of overdose for patients who had an overdose. Our control group, which included patients with OUD who did not have an overdose, was randomly assigned an index date. A total of 66 513 patients with OUD were included for analysis (OD cohort: n = 1413; non-OD cohort: n = 65 100).

Measurements

Monthly adjusted healthcare-related costs and use in the year before and after the index date. We used generalized estimating equation models to compare patients with an opioid overdose and controls in a difference-in-differences framework.

Findings

Compared with the non-OD cohort, an opioid overdose was associated with an increase of $16 890 [95% confidence interval (CI) = $15 611–18 169; P < 0.001] in healthcare costs for an estimated $23.9 million in direct costs to VHA (95% CI = $22.1 million, $25.7 million) within the 30 days following overdose after adjusting for baseline characteristics. Inpatient costs ($13 515; 95% CI = $12 378–14 652; P < 0.001) reflected most of this increase. Inpatient days (+6.15 days; 95% CI, = 5.33–6.97; P < 0.001), inpatient admissions (+1.01 admissions; 95% CI = 0.93–1.10; P < 0.001) and outpatient visits (+1.59 visits; 95% CI = 1.34–1.84; P < 0.001) also increased in the month after opioid overdose. Within the overdose cohort, healthcare costs and use remained higher in the year after overdose compared with pre-overdose trends.

Conclusions

The US Veterans Health Administration patients with opioid use disorder (OUD) who have experienced an opioid overdose have increased healthcare costs and use that remain significantly higher in the month and continuing through the year after overdose than OUD patients who have not experienced an overdose.

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退伍军人健康管理局阿片类药物使用障碍患者阿片类物质过量前后的医疗费用和使用

目的比较经历过阿片类药物过量的美国退伍军人健康管理局（VHA）阿片类使用障碍（OUD）患者（OD队列）和没有经历过阿阿片类物质过量的OUD患者（非OD队列）的医疗费用和使用情况。设计这是一项对管理和临床数据的回顾性队列研究。设置最大的综合性国家医疗保健系统是美国退伍军人健康管理局的医疗保健系统。参与者我们纳入了2017年10月1日至2018年9月30日诊断为OUD的VHA患者。我们确定了服药过量患者的服药过量指标日期。我们的对照组，包括没有服药过量的OUD患者，被随机分配了一个指标日期。共纳入66513名OUD患者进行分析（OD队列：n=1413；非OD队列：n=65100）。测量指数日期前后一年内每月调整的医疗保健相关成本和使用情况。我们使用广义估计方程模型，在差异分析框架中比较阿片类药物过量患者和对照组。研究结果与非OD队列相比，阿片类药物过量与16美元的增加有关 890[95%置信区间（CI） = $15 611–18 169；P <； 0.001]的医疗保健成本，而VHA的直接成本估计为2390万美元（95%置信区间 = $2210万，2570万美元）调整基线特征后用药过量后的天数。住院费用（13美元 515；95%CI = $12 378-14 652；P <； 0.001）反映了这一增长的大部分。住院天数（+6.15 天；95%CI， = 5.33–6.97；P <； 0.001），住院人数（+1.01人；95%置信区间 = 0.93–1.10；P <； 0.001）和门诊就诊（+1.59次就诊；95%CI = 1.34–1.84；P <； 0.001）也在阿片类药物过量后的一个月内增加。在过量用药队列中，与过量用药前的趋势相比，过量用药后一年的医疗费用和使用率仍然较高。结论美国退伍军人健康管理局的阿片类药物使用障碍（OUD）患者经历了阿片类物质过量，其医疗费用和使用量在过量后的一个月内一直显著高于未经历过量的OUD患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.