OBJECTIVES: Opioid dependency (OD) is a mental disorder with a chronic course associated with comorbid mental and somatic disorders as well as a high burden of psychosocial problems. Standard treatment of OD is opioid maintenance treatment (OMT). In the US, OD imposes a significant economic burden on society, with annual societal costs estimated at over 55 billion dollars. Surprisingly, in Europe there is no detailed information on the economic burden of disease conferred by OD. The goal is to gather cost information about OD patients, especially patients in OMT and comparing years with and without relapses.

METHODS: We analysed German health claim data applying a cost-of-illness approach and aimed at examining the direct costs associated with OD. Patients with an ICD-10 code F11.2 were included and assigned to the treatment groups no treatment, or OMT with various maintenance medications. Costs were furthermore stratified for years with and without relapses. Additionally, we compared costs at low, intermediate and high dosage treatment. Group comparisons were performed with ANOVA.

RESULTS: We analysed 3,165 patient years, the total annually sickness funds costs were on average 7,470 € per year and substituted patient and 5,160 € per year for patients without OMT. Comparing the costs of levomethadone (8,400 €), methadone (7,090 €) and buprenorphine (6,670 €) revealed significant lower costs of buprenorphine (p < 0.0001). In years with relapses, costs were higher than in years without relapses (6,500 € vs 7,270 €). Higher pharmaceutical dosages resulted in higher treatment costs in all three substitution treatments. Costs were driven by hospital and pharmaceutical costs. In years with relapses, hospital costs were the major cost driver.

CONCLUSIONS: Patients with an OD in OMT cause more than three-times the cost of an average German patients, with hospital stays and pharmaceutical costs being cost drivers. Preventing relapses might have significant impact on costs.