OBJECTIVES: Opioid utilization within chronic pain populations is a major focus among healthcare providers and policymakers, but less is known about the consequences of treating pain associated with osteoarthritis (“OA”) with prescription opioids (“RxOs”). The goal of this research is to estimate the economic burden (including both all-cause medical and prescription costs) of commercially-insured patients diagnosed with OA of the hip and/or knee before and after treatment with RxOs.

METHODS: The Optum Healthcare Solutions, Inc. data (1/2012-3/2017) were used to identify patients >18 years old with ≥2 diagnoses of hip and/or knee OA, and ≥90 days supply of RxOs during the three-year period from first RxO (index date) after the first OA diagnosis. Patients were required to be continuously-enrolled during the six months before (baseline period) and 36 months after (follow-up period) the index date. Selected demographic and clinical characteristics were compared between the baseline and follow-up periods. Selected drivers of these costs and opioid abuse-related ‘events’ were also evaluated. Costs comparison were normalized over the time periods.

RESULTS: Data for 14,491 patients (62.8% as female, with an average age of 63) with hip and/or knee OA were analyzed. On average, OA patients in the sample were prescribed opioids for 462 days during the follow-up period. All-cause healthcare costs increased by 45% ($19,531), with prescription and hospitalization costs increasing by 324% ($11,248) and 24% ($8,283) respectively. Opioid-related events rose from baseline to follow-up, including rates of opioid misuse (from 0.8% 3.9%), falls (from 1.6% to 8.3%), and fractures (from 4.6% to 17.7%).

CONCLUSIONS: These findings suggest that use of RxOs among OA patients is associated with a rise in the economic burden on payers. Some of these cost increases may be attributed to certain outcomes associated with RxO utilization. This suggests that new treatment options outside of the opioid class are needed.