Incidence of Opioid Use Disorder and the Associated Economic Burden Among People Managing Acute Pain With Prescription Opioids in the United States in Commercial, Medicare, and Medicaid Populations
Author(s)
Andrew J. Schoenfeld, MD, PhD1, Sushanth Jeyakumar, MEng2, Jessica M. Geiger, MPH2, Nicole Princic, MS3, Meghan Moynihan, PhD3, Helen Varker, MS3, Liuhua Shi, ScD2, Ann M. Menzie, MS2;
1Harvard Medical School; Brigham and Women's Hospital, Boston, MA, USA, 2Vertex Pharmaceuticals Incorporated, Boston, MA, USA, 3Merative Health Insights, Cambridge, MA, USA
1Harvard Medical School; Brigham and Women's Hospital, Boston, MA, USA, 2Vertex Pharmaceuticals Incorporated, Boston, MA, USA, 3Merative Health Insights, Cambridge, MA, USA
Presentation Documents
OBJECTIVES: Data on the incidence and economic burden of opioid use disorder (OUD) due to prescription opioids is limited. This study evaluated the incidence of OUD among patients managing acute pain with prescription opioids and assessed the healthcare resource utilization (HCRU) and associated payer costs among patients with and without OUD diagnoses across different payer types in the United States (US).
METHODS: Using the MarketScan Commercial, Medicare, and Multi-state Medicaid Databases (1/1/2015-12/31/2019) previously opioid-naïve adult patients who received ≥1 opioid prescription for acute pain management were identified. Acute pain patients were identified based on <90 days of continuous, or recurrent use, of prescription pain medication within a year of the opioid initiation. Subgroups of patients with or without OUD were identified based on the presence/absence of International Classification of Diseases Tenth Revision diagnosis codes. HCRU and associated payer costs (standardized to 2023 US dollars) were assessed over 12 months post-OUD diagnosis (or from a distribution-matched date for those without OUD).
RESULTS: The 1-, 2-, and 3-year incidence of OUD among patients newly treated with prescription opioids for acute pain were 0.22%, 0.34%, and 0.44%, respectively, in the Commercial population, 0.11%, 0.19%, and 0.29%, respectively, in the Medicare population, and 3.13%, 4.57%, and 5.68%, respectively, in the Medicaid population. Patients diagnosed with OUD had consistently higher HCRU than those without OUD across all payers. The total per-patient, all-cause costs over 1-year for patients with OUD were $25,373 higher in the Commercial population (with OUD $35,765 vs. without OUD $10,392), $20,502 higher in the Medicare population (with OUD $46,908 vs. without OUD $26,406), and $8,887 higher in the Medicaid population (with OUD $16,006 vs. without OUD $7,119).
CONCLUSIONS: The incidence and economic burden of OUD resulting from prescription opioids for acute pain management are substantial, irrespective of payer type.
METHODS: Using the MarketScan Commercial, Medicare, and Multi-state Medicaid Databases (1/1/2015-12/31/2019) previously opioid-naïve adult patients who received ≥1 opioid prescription for acute pain management were identified. Acute pain patients were identified based on <90 days of continuous, or recurrent use, of prescription pain medication within a year of the opioid initiation. Subgroups of patients with or without OUD were identified based on the presence/absence of International Classification of Diseases Tenth Revision diagnosis codes. HCRU and associated payer costs (standardized to 2023 US dollars) were assessed over 12 months post-OUD diagnosis (or from a distribution-matched date for those without OUD).
RESULTS: The 1-, 2-, and 3-year incidence of OUD among patients newly treated with prescription opioids for acute pain were 0.22%, 0.34%, and 0.44%, respectively, in the Commercial population, 0.11%, 0.19%, and 0.29%, respectively, in the Medicare population, and 3.13%, 4.57%, and 5.68%, respectively, in the Medicaid population. Patients diagnosed with OUD had consistently higher HCRU than those without OUD across all payers. The total per-patient, all-cause costs over 1-year for patients with OUD were $25,373 higher in the Commercial population (with OUD $35,765 vs. without OUD $10,392), $20,502 higher in the Medicare population (with OUD $46,908 vs. without OUD $26,406), and $8,887 higher in the Medicaid population (with OUD $16,006 vs. without OUD $7,119).
CONCLUSIONS: The incidence and economic burden of OUD resulting from prescription opioids for acute pain management are substantial, irrespective of payer type.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE308
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)