TABLE 1.
Health Care Utilization and Costs Among Opioid-Naive Patients with New Persistent Opioid Use Versus Patients Without Persistent Use in the Year Following a Major Inpatient Surgerya
| Commercial | Medicare | Medicaid | ||||
|---|---|---|---|---|---|---|
| New Persistent Opioid Use (n = 33,811) | No Persistent Opioid Use (n = 793,722) | New Persistent Opioid Use (n = 10,363) | No Persistent Opioid Use (n = 175,791) | New Persistent Opioid Use (n = 7,445) | No Persistent Opioid Use (n = 97,289) | |
| Health care utilization | ||||||
| Inpatient admissions, n (%) | 5,846 (17.3) | 46,056 (5.8)c | 2,063 (19.9) | 24,247 (13.8)c | 1,811 (24.3) | 9,042 (9.3)c |
| Emergency department visits, n (%) | 12,838 (38.0) | 160,241 (20.2)c | 4,504 (43.5) | 56,225 (32.0)c | 5,307 (71.3) | 46,029 (47.3)c |
| Ambulance/paramedic services, n (%) | 2,958 (8.8) | 23,990 (3.0)c | 2,405 (23.2) | 29,095 (16.6)c | 2,023 (27.2) | 11,239 (11.6)c |
| Pharmacy prescriptions | ||||||
| Opioid prescriptions, n (%)b | 33,620 (99.4) | 617,096 (77.7)c | 10,295 (99.3) | 101,676 (57.8)c | 7,421 (99.7) | 80,072 (82.3)c |
| Opioid prescriptions per patient, mean (SD)b | 6.4 (4.9) | 1.3 (1.3)c | 6.1 (4.5) | 1.1 (1.5)c | 7.9 (6.8) | 1.5 (1.5)c |
| Total opioid dose per patient, in MMEs, mean (SD) | 3,851 (4,961) | 543 (896)c | 3,577 (3,999) | 507 (943)c | 3,852 (5,944) | 422 (824)c |
| Nonopioid prescriptions, n (%) | 33,369 (98.7) | 704,586 (88.8)c | 10,321 (99.6) | 165,852 (94.4)c | 7,380 (99.1) | 85,343 (87.7)c |
| Nonopioid prescriptions per patient, mean (SD) | 28.2 (24.5) | 14.9 (17.9)c | 39.1 (28.0) | 29.6 (24.5)c | 45.1 (50.1) | 19.3 (32.9)c |
| Health care costs, $, mean (SD) | ||||||
| Total medical costs | 30,827 (70,438) | 9,044 (34,410)c | 26,851 (74,277) | 17,703 (47,085)c | 13,247 (39,105) | 4,875 (23,363)c |
| Inpatient admissions | 7,391 (37,052) | 1,824 (19,327)c | 4,748 (26,378) | 3,466 (21,900)c | 5,770 (29,851) | 1,754 (17,889)c |
| Outpatient services | 23,436 (51,705) | 7,220 (25,345)c | 22,103 (66,505) | 14,237 (38,738)c | 7,477 (20,316) | 3,121 (12,707)c |
| Emergency department visits | 889 (3,286) | 350 (1,824)c | 828 (3,054) | 601 (3,002)c | 623 (1,913) | 202 (742)c |
| Office visits | 1,336 (2,021) | 693 (1,224)c | 1,366 (2,008) | 1,088 (1,412)c | 476 (738) | 206 (385)c |
| Ambulance/paramedic services | 178 (1,485) | 54 (818)c | 307 (1,145) | 219 (1,300)c | 125 (652) | 34 (260)c |
| Other | 21,033 (50,321) | 6,122 (24,631)c | 19,603 (65,563) | 12,328 (37,815)c | 6,254 (19,643) | 2,680 (12,430)c |
| Pharmacy costsb | 4,188 (12,196) | 1,945 (8,841)c | 4,657 (10,638) | 3,456 (7,926)c | 2,801 (8,949) | 1,143 (7,567)c |
| Opioid prescriptionsb | 179 (1,357) | 18 (58)c | 130 (335) | 16 (161)c | 162 (803) | 11 (160)c |
| Nonopioid prescriptions | 4,009 (12,063) | 1,928 (8,840)c | 4,528 (10,613) | 3,439 (7,923)c | 2,639 (8,854) | 1,133 (7,562)c |
| Total health care costsb | 35,015 (74,312) | 10,989 (36,833)c | 31,508 (76,299) | 21,159 (48,461)c | 16,048 (42,192) | 6,018 (25,902)c |
aExcludes the index admission.
bIncludes any opioid prescriptions received in the perioperative period. A small number of patients qualified for the new persistent use cohort by HCPCS codes only, which are captured under outpatient medical services and thus did not have an opioid prescription.
c P < 0.001, new persistent opioid use versus no persistent opioid use.
HCPCS = Healthcare Common Procedure Coding System; MMEs = morphine milligram equivalents.