目的:(a)描述阿片类药物滥用者的人口统计学特征;(b)比较选定的合并症患病率以及阿片类药物滥用者与对照组患者的医疗和药物利用模式,1998年至2002年期间;(c)计算平均每位患者的年度总医疗费用(例如,住院,门诊病人,急诊室,药物,其他)从私人付款人的角度来看。
方法:使用1998年至2002年的16项自我保险的雇主健康计划的医疗和药房索赔管理数据库,其中约有200万人的生命,用于识别“阿片类药物滥用者”-与ICD-9-CM(国际疾病分类,第九次修订,临床修改)阿片类药物滥用的代码(304.0、304.7、305.5和965.0[不包括965.01])。使用匹配的样本(按年龄,性别,就业状况,和人口普查区域),比例为3:1。每位患者的年度医疗保健费用(平均医疗和药物总费用)以2003年的美元计算。多变量回归技术也用于控制合并症,并将成本与抑郁症患者的基准进行比较。
结果:740名患者被确定为阿片类药物滥用者,每10,000名年龄在12至64岁的人群中,有8人连续参加医疗保健计划,他们有12个月的数据可用于计算成本.阿片类药物滥用者,与不施虐者相比,一些特定合并症的患病率明显较高,包括非阿片类药物中毒,肝炎(A,B,或C),精神疾病,和胰腺炎,分别高出约78、36、9和21(P<0.01)倍,分别,与不虐待者相比。阿片类药物滥用者的医疗和处方药利用率也较高。几乎60%的阿片类药物滥用者有阿片类药物的处方药要求,而非滥用者约为20%。阿片类药物滥用者住院率高于非滥用者12倍以上(P<0.01)。阿片类药物滥用者的平均年度直接医疗保健费用是非滥用者的8倍以上(分别为15,884美元和1,830美元,P<0.01)。医院住院和门诊费用占阿片类药物滥用者医疗保健费用的46%(7,239美元)和31%(5,000美元),与17%(310美元)和50%(906美元)相比,分别,不施虐者。阿片类药物滥用者的平均药物成本是非滥用者的5倍以上(2,034美元对分别为386美元,P<0.01),受阿片类药物滥用者更高的药物利用率(包括阿片类药物)的驱动。即使使用抑郁症患者的匹配对照的多元回归模型来控制合并症,阿片类药物滥用者的平均医疗费用比抑郁症患者的平均医疗费用高1.8倍.
结论:阿片类药物滥用的高成本主要是由于昂贵的合并症的高患病率以及医疗服务和处方药的高利用率。
背景:这项研究的资金来自JanssenMedicalAffairs的无限制拨款,L.L.C.由作者SusanVallow和JeffSchein获得,他们受雇于詹森医疗事务,L.L.C.NathanielKatz是Janssen和许多其他制药公司的顾问,这些公司生产品牌阿片类药物和非阿片类镇痛药;作者AlanG.White,HowardG.Birnbaum,MilenaN.Mareva,MahamDaher透露与本文相关的任何潜在偏见或利益冲突。怀特是这项研究的主要作者。研究概念和设计主要由怀特贡献,Vallow,沙因,还有Katz.数据的分析和解释由所有作者贡献。手稿的起草主要是怀特的工作,它的关键修订是怀特和瓦洛的作品。统计专业知识由怀特贡献,Birnbaum,还有Daher,行政,技术,和/或材料支持由分析小组提供,Inc.,波士顿,
OBJECTIVE: To (a) describe the demographics of opioid abusers; (b) compare the prevalence rates of selected comorbidities and the medical and drug utilization patterns of opioid abusers with patients from a control group, for the period from 1998 to 2002; and (c) calculate the mean annual per-patient total health care costs (e.g., inpatient, outpatient, emergency room, drug, other) from the perspective of a private payer.
METHODS: An administrative database of medical and pharmacy claims from 1998 to 2002 of 16 self-insured employer health plans with approximately 2 million lives was used to identify \"opioid abusers\"-patients with claims associated with ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes for opioid abuse (304.0, 304.7, 305.5, and 965.0 [excluding 965.01]). A control group of nonabusers was selected using a matched sample (by age, gender, employment status, and census region) in a 3:1 ratio. Per-patient annual health care costs (mean total medical and drug costs) were measured in 2003 U.S. dollars. Multivariate regression techniques were also used to control for comorbidities and to compare costs with a benchmark of depressed patients.
RESULTS: 740 patients were identified as opioid abusers, a prevalence of 8 in 10,000 persons aged 12 to 64 years continuously enrolled in health care plans for whom 12 months of data were available for calculating costs. Opioid abusers, compared with nonabusers, had significantly higher prevalence rates for a number of specific comorbidities, including nonopioid poisoning, hepatitis (A, B, or C), psychiatric illnesses, and pancreatitis, which were approximately 78, 36, 9, and 21 (P<0.01) times higher, respectively, compared with nonabusers. Opioid abusers also had higher levels of medical and prescription drug utilization. Almost 60% of opioid abusers had prescription drug claims for opioids compared with approximately 20% for nonabusers. Prevalence rates for hospital inpatient visits for opioid abusers were more than 12 times higher compared with nonabusers (P<0.01). Mean annual direct health care costs for opioid abusers were more than 8 times higher than for nonabusers ($15,884 versus $1,830, respectively, P < 0.01). Hospital inpatient and physician-outpatient costs accounted for 46% ($7,239) and 31% ($5,000) of opioid abusers\' health care costs, compared with 17% ($310) and 50% ($906), respectively, for nonabusers. Mean drug costs for opioid abusers were more than 5 times higher than costs for nonabusers ($2,034 vs. $386, respectively, P<0.01), driven by higher drug utilization (including opioids) for opioid abusers. Even when controlling for comorbidities using a multivariate regression model of a matched control of depressed patients, the average health care costs of opioid abusers were 1.8 times higher than the average health care costs of depressed patients.
CONCLUSIONS: The high costs of opioid abuse were driven primarily by high prevalence rates of costly comorbidites and high utilization rates of medical services and prescription drugs.
BACKGROUND: Funding for this research was provided by an unrestricted grant from Janssen Medical Affairs, L.L.C. and was obtained by authors Susan Vallow and Jeff Schein, who are employed by Janssen Medical Affairs, L.L.C. Nathaniel Katz is a consultant to Janssen and numerous other pharmaceutical companies that manufacture branded opioid products and nonopioid analgesics; authors Alan G. White, Howard G. Birnbaum, Milena N. Mareva, and Maham Daher disclose no potential bias or conflict of interest relating to this article. White served as principal author of the study. Study concept and design were contributed primarily by White, Vallow, Schein, and Katz. Analysis and interpretation of data were contributed by all authors. Drafting of the manuscript was primarily the work of White, and its critical revision was the work of White and Vallow. Statistical expertise was contributed by White, Birnbaum, and Daher, and administrative, technical, and/or material support was provided by Analysis Group, Inc., Boston, MA.