OBJECTIVES: COPD contributes significant economic burden worldwide and is the third leading cause of mortality. The potential impact of concurrent prescription opioid use on healthcare costs among patients with COPD is not well understood. The study objective was to assess the impact of long-term prescription opioid use (≥90-day supply in a one-year period) compared to no opioid use on all-cause healthcare costs among patients with COPD.

METHODS: Patients with COPD diagnosis were identified using ICD9-CM diagnosis codes and COPD maintenance medication prescription claims from the Truven Health MarketScan^® Commercial Claims and Encounters Database from July 1, 2008 to December 31, 2009. COPD patients with prescription opioid claims were matched 1:1 to non-users of opioids on age, sex, severe and moderate COPD exacerbations, oxygen therapy use, short-acting beta₂-agonist use, maintenance medication adherence, and asthma. Generalized linear regression model with gamma distribution and log-link function was used to identify the adjusted impact of long-term prescription opioid use versus no opioid use on direct, all-cause healthcare costs (prescription medications and medical costs) in a one-year period among COPD patients.

RESULTS: A total of 5,541 matched pairs of prescription opioid users versus non-users of opioids were identified. Long-term prescription opioid users (n=566) had significantly higher mean Deyo-Charlson comorbidity scores (2.4±1.8 vs 1.7±1.2, p<0.0001), presence of comorbid chronic conditions (86.6% vs 76.3%, p<0.0001) and comorbid pain conditions (93.5% vs 70.7%, p<0.0001) compared to non-users of opioids. After adjusting for confounders, long-term prescription opioid users had significantly higher healthcare costs ($23,996 ± 1,106 vs. $13,394 ± 513, p<0.0001) compared to non-users of opioids among COPD patients.

CONCLUSIONS: Long-term use of prescription opioids among COPD patients is associated with significantly higher all-cause healthcare costs. Additional research is needed to improve the management of COPD patients using prescription opioids on a long-term basis to lower healthcare costs.