OBJECTIVES

: The objective of the study was to determine the differences in OUD-related and all-cause healthcare utilization and direct costs between patients with OUD alone and patients with OUD and psychiatric comorbidities.

METHODS

Using commercial insurance claims within the IQVIATM PharMetrics Plus claims database, from 01/2007 to 9/2017, we compared the healthcare utilization and costs of patients who have OUD alone to those with concurrent OUD and mental health disorders. We selected patients who were 18 to 64 years old and had at least one diagnosis of OUD. Patients were followed for 12 months from the date of first claim of an OUD diagnosis code. The utilization of healthcare was estimated using negative binomial regression adjusting for covariates. All costs were estimated using a two-part model, which uses logistic regression to model the probability of positive costs and GLM to estimate costs among those who have positive costs

RESULTS

OUD patients with comorbid mental health conditions were more likely to have higher all-cause inpatient (IRR=1.98, 95% CI=1.87-2.10), outpatient (IRR=1.36, 95% CI=1.32-1.43), ED visits (IRR=1.88, 95% CI =1.75-2.05), psychosocial services (IRR=1.74, 95% CI=1.72-2.05). All-cause total costs were also higher among patients with comorbid mental health conditions ($20539 vs. $10213, p <0.01), inpatient ($13510 vs. $6301, p<0.01), outpatient ($1860 vs. $1217, p<0.01), ED visits ($1539 vs $598, p<0.01), prescription costs ($4632 vs. $3316, p<0.01). Among patients with mental health conditions, those with three or more conditions had higher total healthcare costs compared to those with fewer than three.

CONCLUSIONS

: The comorbidity of mental health conditions and OUD adds complexity and greater health care utilization and costs to the treatment of drug dependence in commercially insured populations. This finding warrants the consideration of integrating mental health and psycho-social support in the treatment of drug dependence.