TRENDS IN INPATIENT COSTS AND DRIVERS OF HIGH-COST HOSPITALIZATIONS AMONG INDIVIDUALS WITH OPIOID USE DISORDER
Author(s)
Godwin E. Okoye, MS, RPh1, Curtis Bone, MD, MHS2, Chanhyun Park, MEd, RPh, PhD1, Jimmy Arnold, MBA3, Anton Avanceña, PhD1;
1The University of Texas at Austin College of Pharmacy, Health Outcomes Division, Austin, TX, USA, 2The University of Texas at San Antonio, Department of Family Medicine, San Antonio, Texas, USA, San Antonio, TX, USA, 3The University of Texas at San Antonio, Long School of Medicine, San Antonio, Texas, USA, San Antonio, TX, USA
1The University of Texas at Austin College of Pharmacy, Health Outcomes Division, Austin, TX, USA, 2The University of Texas at San Antonio, Department of Family Medicine, San Antonio, Texas, USA, San Antonio, TX, USA, 3The University of Texas at San Antonio, Long School of Medicine, San Antonio, Texas, USA, San Antonio, TX, USA
OBJECTIVES: Inpatient care for individuals with opioid use disorder (OUD) represents a substantial and growing economic burden. This study examined trends in inpatient costs and predictors of high-cost hospitalizations among individuals with OUD in the US.
METHODS: We conducted a retrospective cross-sectional analysis using the National Inpatient Sample (NIS) from 2019-2022. Adult inpatient hospitalizations with an OUD diagnosis were identified using ICD-10-CM codes. Total inpatient costs were estimated using hospital-specific cost-to-charge ratios and adjusted for inflation using the Consumer Price Index. All analyses incorporated NIS discharge weights, strata, and clustering to generate nationally representative estimates. Temporal trends in mean inpatient costs were assessed. Generalized linear models (GLM) with a gamma distribution and log link were used to identify predictors of total inpatient cost. In secondary analyses, high-cost hospitalizations were defined as costs at or above the 90th percentile ($39,609), and multivariable logistic regression was used to identify predictors of high-cost admissions.
RESULTS: We included 712,172 inpatient hospitalizations (weighted N=3,560,859). Cost increased from $17,234 in 2019 to $19,647 in 2022. Higher costs were significantly associated with older age, greater numbers of diagnoses and procedures, longer length of stay, higher OUD severity, elective admissions, amputation and debridement procedures, and higher income-levels (all p<0.01). Compared to White individuals, all racial minority groups had significantly higher costs. Relative to New England, hospitalizations in other census divisions were associated with lower costs, except Pacific division. High-cost hospitalization analyses were largely consistent; however, female (OR:0.86, 95%CI 0.83-0.88, p<0.001) and amputation (OR:0.84, 95%CI 0.75-0.95, p<0.01) patients were less likely to incur high-cost admissions.
CONCLUSIONS: Inpatient costs among individuals with OUD increased from 2019 to 2022, with costs concentrated among a subset of high-cost hospitalizations. Clinical complexity, OUD severity, and regional variation were key drivers of elevated costs, highlighting opportunities for targeted interventions to reduce high-cost inpatient utilization.
METHODS: We conducted a retrospective cross-sectional analysis using the National Inpatient Sample (NIS) from 2019-2022. Adult inpatient hospitalizations with an OUD diagnosis were identified using ICD-10-CM codes. Total inpatient costs were estimated using hospital-specific cost-to-charge ratios and adjusted for inflation using the Consumer Price Index. All analyses incorporated NIS discharge weights, strata, and clustering to generate nationally representative estimates. Temporal trends in mean inpatient costs were assessed. Generalized linear models (GLM) with a gamma distribution and log link were used to identify predictors of total inpatient cost. In secondary analyses, high-cost hospitalizations were defined as costs at or above the 90th percentile ($39,609), and multivariable logistic regression was used to identify predictors of high-cost admissions.
RESULTS: We included 712,172 inpatient hospitalizations (weighted N=3,560,859). Cost increased from $17,234 in 2019 to $19,647 in 2022. Higher costs were significantly associated with older age, greater numbers of diagnoses and procedures, longer length of stay, higher OUD severity, elective admissions, amputation and debridement procedures, and higher income-levels (all p<0.01). Compared to White individuals, all racial minority groups had significantly higher costs. Relative to New England, hospitalizations in other census divisions were associated with lower costs, except Pacific division. High-cost hospitalization analyses were largely consistent; however, female (OR:0.86, 95%CI 0.83-0.88, p<0.001) and amputation (OR:0.84, 95%CI 0.75-0.95, p<0.01) patients were less likely to incur high-cost admissions.
CONCLUSIONS: Inpatient costs among individuals with OUD increased from 2019 to 2022, with costs concentrated among a subset of high-cost hospitalizations. Clinical complexity, OUD severity, and regional variation were key drivers of elevated costs, highlighting opportunities for targeted interventions to reduce high-cost inpatient utilization.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PT27
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies