Abstract：
UNASSIGNED: Healthcare providers may be utilizing central nervous system (CNS) depressants to reduce opioid use due to recent changes in public policy. Combination use of these agents with opioids increases the risk of respiratory depression and death. Healthcare expenditures by individuals using these drug combinations have not been previously quantified. We sought to characterize healthcare costs and expenditures associated with a population reporting concurrent CNS depressants and opioid use compared with nonopioid analgesics in the United States from 2009 to 2019.
UNASSIGNED: A serial cross-sectional design was used to compare the healthcare expenditures of adult Medical Expenditure Panel Survey respondents who were prescribed nonopioid analgesics, opioids only, opioids/benzodiazepines (BZD), opioids/BZD/skeletal muscle relaxants (SMR), or opioids/gabapentin (gaba) using pooled data from 2009 to 2019. Expenditure (cost and resource utilization) categories included inpatient, outpatient, office-based, and prescription medicine. Average marginal effects were used to compare survey-weighted annual costs and resource utilizations across the groups as compared to nonopioid analgesic respondents, adjusted for covariates.
UNASSIGNED: A weighted total of 34 241 838 individuals were identified. Most were opioid-only respondents (46.5%), followed by nonopioid analgesic (43.4%), opioid/BZD (5.3%), opioid-gaba (3.5%), and opioid/BZD/SMR respondents (1.3%). In comparison to the study groups with nonopioid analgesics, opioid-gaba users had the highest significant incremental cost difference among the different pairings (+$11 684, P < .001). Opioid-gaba, opioid/BZD, and opioid/BZD/SMR respondents had significantly higher inpatient, emergency department, and prescription drug costs and use compared to nonopioid analgesic respondents. Opioid-only respondents had higher outpatient and office-based costs and visits compared to nonopioid analgesic respondents.
UNASSIGNED: As healthcare providers seek to utilize fewer opioids for pain management, attention must be paid to ensuring safe and effective use of concurrent CNS depressants to mitigate high healthcare costs and burden.
UNASSIGNED: A serial cross-sectional design was used to compare the healthcare expenditures of adult Medical Expenditure Panel Survey respondents who were prescribed nonopioid analgesics, opioids only, opioids/benzodiazepines (BZD), opioids/BZD/skeletal muscle relaxants (SMR), or opioids/gabapentin (gaba) using pooled data from 2009 to 2019. Expenditure (cost and resource utilization) categories included inpatient, outpatient, office-based, and prescription medicine. Average marginal effects were used to compare survey-weighted annual costs and resource utilizations across the groups as compared to nonopioid analgesic respondents, adjusted for covariates.
UNASSIGNED: A weighted total of 34 241 838 individuals were identified. Most were opioid-only respondents (46.5%), followed by nonopioid analgesic (43.4%), opioid/BZD (5.3%), opioid-gaba (3.5%), and opioid/BZD/SMR respondents (1.3%). In comparison to the study groups with nonopioid analgesics, opioid-gaba users had the highest significant incremental cost difference among the different pairings (+$11 684, P < .001). Opioid-gaba, opioid/BZD, and opioid/BZD/SMR respondents had significantly higher inpatient, emergency department, and prescription drug costs and use compared to nonopioid analgesic respondents. Opioid-only respondents had higher outpatient and office-based costs and visits compared to nonopioid analgesic respondents.
UNASSIGNED: As healthcare providers seek to utilize fewer opioids for pain management, attention must be paid to ensuring safe and effective use of concurrent CNS depressants to mitigate high healthcare costs and burden.
摘要：
■由于最近公共政策的变化，医疗保健提供者可能正在利用中枢神经系统（CNS）抑制剂来减少阿片类药物的使用。这些药物与阿片类药物的联合使用会增加呼吸抑制和死亡的风险。使用这些药物组合的个人的医疗保健支出之前尚未量化。我们试图描述2009年至2019年美国与非阿片类镇痛药相比，与并发中枢神经系统抑制剂和阿片类药物使用的人群相关的医疗保健成本和支出。
■使用连续横截面设计来比较成人医疗支出小组调查受访者的医疗支出，只有阿片类药物，阿片类药物/苯二氮卓类药物（BZD），阿片类药物/BZD/骨骼肌松弛剂（SMR），或阿片类药物/加巴喷丁（gaba）使用2009年至2019年的汇总数据。支出(成本和资源利用率)类别包括住院、门诊病人,办公,和处方药。平均边际效应用于比较各组与非阿片类镇痛药受访者相比的调查加权年度成本和资源利用率。针对协变量进行调整。
■确定了34241838个人的加权总数。大多数是仅使用阿片类药物的受访者（46.5％），其次是非阿片类镇痛药（43.4％），阿片类药物/BZD（5.3%），阿片类gaba（3.5％），和阿片类药物/BZD/SMR受访者（1.3%）。与使用非阿片类镇痛药的研究组相比，阿片类药物-gaba使用者在不同配对中的增量成本差异最大(+$11684，P<.001)。阿片类药物-gaba,阿片类药物/BZD，阿片类药物/BZD/SMR受访者的住院患者明显较高，急诊科,以及与非阿片类镇痛药受访者相比的处方药成本和使用情况。与非阿片类镇痛药的受访者相比，仅阿片类药物的受访者的门诊和办公室费用和就诊次数更高。
■随着医疗保健提供者寻求使用更少的阿片类药物进行疼痛管理，必须注意确保安全和有效地使用并发中枢神经系统抑制剂，以减轻高昂的医疗保健成本和负担。
■使用连续横截面设计来比较成人医疗支出小组调查受访者的医疗支出，只有阿片类药物，阿片类药物/苯二氮卓类药物（BZD），阿片类药物/BZD/骨骼肌松弛剂（SMR），或阿片类药物/加巴喷丁（gaba）使用2009年至2019年的汇总数据。支出(成本和资源利用率)类别包括住院、门诊病人,办公,和处方药。平均边际效应用于比较各组与非阿片类镇痛药受访者相比的调查加权年度成本和资源利用率。针对协变量进行调整。
■确定了34241838个人的加权总数。大多数是仅使用阿片类药物的受访者（46.5％），其次是非阿片类镇痛药（43.4％），阿片类药物/BZD（5.3%），阿片类gaba（3.5％），和阿片类药物/BZD/SMR受访者（1.3%）。与使用非阿片类镇痛药的研究组相比，阿片类药物-gaba使用者在不同配对中的增量成本差异最大(+$11684，P<.001)。阿片类药物-gaba,阿片类药物/BZD，阿片类药物/BZD/SMR受访者的住院患者明显较高，急诊科,以及与非阿片类镇痛药受访者相比的处方药成本和使用情况。与非阿片类镇痛药的受访者相比，仅阿片类药物的受访者的门诊和办公室费用和就诊次数更高。
■随着医疗保健提供者寻求使用更少的阿片类药物进行疼痛管理，必须注意确保安全和有效地使用并发中枢神经系统抑制剂，以减轻高昂的医疗保健成本和负担。
