USING PRIVATE CLAIMS DATA TO STUDY THE COST OF THE OPIOID CRISIS
Author(s)
Gelburd R, Russo A
FAIR Health, New York, NY, USA
Presentation Documents
OBJECTIVES : Identify trends in healthcare costs and demand for services attributable to the opioid epidemic nationwide 2011-2015. METHODS : FAIR Health analyzed its dataset of billions of private healthcare claims records to identify claims with ICD-9-CM and ICD-10-CM diagnostic codes indicative of opioid abuse and dependence, then aggregated the data by key fields such as state, procedure code and year of service, and determined cost by both charges and imputed allowed amounts. RESULTS : From 2011 to 2015, the national aggregated dollar value of charges for opioid abuse and dependence and imputed allowed amounts for such diagnoses rose over 1,000 percent. In 2015, private payors’ average costs for a patient diagnosed with opioid abuse or dependence were 556 percent higher—almost $16,000 more per patient—than the per-patient average cost based on all patients’ claims. From 2011 to 2014, the greatest increase in services for patients diagnosed with opioid abuse and dependence was in alcohol and/or drug services/therapy, which increased 1,189 percent, followed by laboratory tests at 848 percent. States’ average charges for services associated with opioid abuse and dependence diagnoses varied widely. In 2014, the states with the highest associated average per-service charges were Iowa ($263) and Washington, DC ($247). Those with the lowest were Rhode Island ($45) and South Carolina ($60). CONCLUSIONS : The opioid crisis is having a profound economic impact on the healthcare system. Both billed charges and allowed amounts for services associated with opioid abuse and opioid dependence have increased dramatically in recent years. Certain categories of care, including alcohol and/or drug services/therapy and laboratory tests, have increased in utilization more than others. Although states vary in the level of their average per-service charges, the overall pattern is one of increasing demand for treatment for opioid abuse and dependence, with correspondingly higher costs for payors.
Conference/Value in Health Info
2018-05, ISPOR 2018, Baltimore, MD, USA
Value in Health, Vol. 21, S1 (May 2018)
Code
PMH21
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Mental Health