OBJECTIVES: To evaluate economic burden among illicit-use opioid overdose patients, with and without respiratory comorbidity, on MOUD.

METHODS: This retrospective analysis used anonymized Commercial, Managed Medicare and Medicaid patient claims from the US Optum database. Illicit-use opioid overdose patients without an opioid prescription, with respiratory co-morbidity (RIOP) and without (IOP) in the pre-index period between Jan 2016–Dec 2019 were identified. Patients >18 years at index, with a minimum continuous enrollment of 365 days pre- and 365 days post-index event date, with MOUD as assessed at index event (first) using the most recent record prior to index period (with RIOP-RX and IOP-RX) were included. RIOP-RX and IOP-RX by insurance, naloxone, state, comorbidities, and costs were analyzed.

RESULTS: 176 RIOP-RX and 1,494 IOP-RX were identified. RIOP-RX and IOP-RX < 50 years were: 63.64% vs. 88.09%; average age 43 vs. 35 years; male 52.27% vs. 63.19%; Caucasian 58.52% vs. 73.83%; Charlson comorbidity index 2.27 vs. 0.58; and Medicaid 76.70% vs. 77.71%, respectively. States with the highest RIOP-RX and IOP-RX were NJ (22.16% vs. 11.18%), OH (13.64% vs. 20.68%), TN (11.93% vs. 4.35%), NY (9.63% vs.10.17%), PA (8.52% vs. 11.65%), and LA (3.41% vs. 7.16%). Average index event costs for RIOP-RX and IOP-RX were $4,287.76 vs. $3,278.76, respectively. RIOP-RX with and without naloxone were $1,976.95 vs. $4,551.02; and IOP-RX $1,308.78 vs. $3,515.04, respectively. Most prevalent Charlson comorbidities among RIOP-RX included mild liver disease, diabetes with chronic complications, congestive heart failure, malignancy, and renal disease. Based on a conservative estimate, treating 100,000 RIOP-RX and IOP-RX annually may cost ~$428 and $327 billion to a plan, respectively.

CONCLUSIONS: In this study RIOP-RX and IOP-RX demonstrated significant economic burden, while naloxone recipients had lower costs. Future research should explore naloxone co-prescribing benefits among these patients.