OBJECTIVES : To compare the healthcare expenditures of older US adults (≥50 years) with comorbid hypercholesterolemia and pain who use opioid medications and those who do not.

METHODS : This study utilized a retrospective, cross-sectional database design of 2017 Medical Expenditure Panel Survey (MEPS) data. Eligible subjects were those alive for the full calendar year, aged ≥50 years, had a diagnosis of hypercholesterolemia, and reported having pain in the past four weeks. Hierarchical linear regression models were developed to investigate differences in healthcare expenditures (inpatient, outpatient, office-based, emergency room, prescription medications, other, and total costs) between opioid users and non-users. Covariates included predisposing, enabling, need, personal health practices, and external environmental factors. National estimates were obtained by adjusting for the complex MEPS design. An alpha level of 0.05 was set a priori.

RESULTS : The study included 2,796 eligible subjects (59.7% aged ≥65 years, 53.5% female, 81.9% white), providing a national estimate of 28,483,745 non-institutionalized older adults with hypercholesterolemia and pain in the US in 2017. Of these, 795 subjects (weighted national estimate 8,079,019 [28.4%]) were categorized as opioid users. After adjusting for predisposing, enabling, need, personal health practices, and external environmental factors, opioid users had 36% greater inpatient expenditure (β=0.310, p=0.0010), 41% greater outpatient expenditure (β=0.341, p<0.0001), 53% greater office-based expenditure (β=0.426, p<0.0001), 62% greater prescription medication expenditure (β=0.483, p<0.0001), 32% greater other healthcare expenditure (β=0.278, p=0.0023), and 79% greater total healthcare expenditure (β=0.581, p<0.0001) versus non-users. However, compared to non-users, opioid users had 8% lower adjusted emergency room expenditures (β=-0.078, p=0.0007).

CONCLUSIONS : Adjusted healthcare expenditures were greater among opioid users compared to non-users with hypercholesterolemia and pain for all expenditure categories except emergency room expenditures, which were lower. Further research is warranted to investigate these expenditures in greater depth, over longer time periods, and additional populations.