OBJECTIVES

Despite the rise in opioid abuse and dependence, there has been little research on the geographic variation of healthcare utilization. The objective was to estimate the geographic variation in costs, payments, and length of stay (LOS) associated with inpatient opioid related hospital visits in a large hospital claims database.

METHODS

The Vizient Health System Database was used to identify opioid related patient visits between January 2014 and June 2017. Eligible visits had a primary diagnosis of opioid use or dependence defined by International Classification of Diseases, 9^th and 10^th Revision (ICD-9/10). Geography was defined using the 9 US Census sub-regions. Multivariable regression models were performed to estimate the mean expected cost and payment per visit for each region controlling for patient demographics, comorbid conditions, hospital characteristics, and year.

RESULTS :

A total of 32,713 hospital inpatient visits were identified in 359 hospitals. The overall adjusted mean cost, payment, and LOS for an opioid visit was $4,383, $6,689, and 4.35 days, respectively. The adjusted mean expected cost was $3,336, $2,894, $5,835, $4,472, $4,885, $6,671, $3,979, $5,192, $3,520 in the East North Central, East South Central, Mid-Atlantic, Mountain, New England, Pacific, South Atlantic, West North Central, and West South Central regions. The adjusted mean expected payment was $7,984, $4,038, $7,070, $9,001, $7,897, $8,183, $5,551, $6,490, $5,617 in the East North Central, East South Central, Mid-Atlantic, Mountain, New England, Pacific, South Atlantic, West North Central, and West South Central regions. The Pacific and East North Central Region had the highest (4.95 days) and lowest (3.77 days) LOS, respectively.

CONCLUSIONS

The cost and payment of treating an opioid related visit was highest in Mid-Atlantic and Pacific regions, respectively. Visit-associated costs associated were lower than the payment. Opioid related visits are a highly prevalent and costly epidemic placing a large burden on US hospitals.