TABLE 2.
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 Outpatient Surgerya
| Commercial | Medicare | Medicaid | |||||
|---|---|---|---|---|---|---|---|
| New Persistent Opioid Use (n = 31,561) | No Persistent Opioid Use (n = 1,511,004) | New Persistent Opioid Use (n = 5,829) | No Persistent Opioid Use (n = 385,047) | New Persistent Opioid Use (n = 6,072) | No Persistent Opioid Use (n = 88,806) | ||
| Health care utilization | |||||||
| Inpatient admissions, n (%) | 2,990 (9.5) | 49,399 (3.3)c | 1,424 (24.4) | 37,528 (9.8)c | 947 (15.6) | 7,851 (8.8)c | |
| Emergency department visits, n (%) | 10,991 (34.8) | 242,919 (16.1)c | 2,514 (43.1) | 83,223 (21.6)c | 4,349 (71.6) | 39,859 (44.9)c | |
| Ambulance/paramedic services, n (%) | 1,576 (5.0) | 26,146 (1.7)c | 1,145 (19.6) | 31,290 (8.1)c | 1,078 (17.8) | 8,639 (9.7)c | |
| Pharmacy prescriptions | |||||||
| Opioid prescriptions, n (%)b | 31,561 (100.0) | 1,051,611 (69.6)c | 5,829 (100.0) | 133,906 (34.8)c | 6,072 (100.0) | 67,829 (76.4)c | |
| Opioid prescriptions per patient, mean (SD)b | 5.2 (3.8) | 1.0 (1.1)c | 5.3 (3.8) | 0.5 (1.0)c | 6.6 (5.0) | 1.4 (1.5)c | |
| Total opioid dose per patient, in MMEs, mean (SD) | 2,595 (3,556) | 403 (724)c | 2,853 (3,532) | 194 (565) | 2,807 (4,262) | 417 (781)c | |
| Nonopioid prescriptions, n (%) | 30,978 (98.2) | 1,292,940 (85.6)c | 5,814 (99.7) | 361,503 (93.9)c | 6,041 (99.5) | 78,229 (88.1)c | |
| Nonopioid prescriptions per patient, mean (SD) | 23.6 (22.1) | 13.3 (16.0)c | 38.6 (28.5) | 24.9 (21.7)c | 40.6 (43.7) | 27.6 (39.0)c | |
| Health care costs, $, mean (SD) | |||||||
| Total medical costs | 16,836 (44,698) | 5,589 (19,533)c | 26,093 (65,080) | 10,457 (30,933)c | 7,648 (20,418) | 4,927 (18,137)c | |
| Inpatient admissions | 2,978 (18,699) | 677 (8,757)c | 5,969 (21,863) | 2,051 (12,705)c | 2,201 (13,512) | 1,058 (10,319)c | |
| Outpatient services | 13,857 (36,333) | 4,912 (16,457)c | 20,124 (56,379) | 8,406 (26,126)c | 5,448 (13,087) | 3,869 (13,868)c | |
| Emergency department visits | 711 (2,396) | 238 (1,336)c | 826 (3,308) | 357 (2,094)c | 492 (1,247) | 184 (663)c | |
| Office visits | 1,036 (1,638) | 577 (754)c | 1,393 (1,902) | 847 (1,069)c | 469 (676) | 249 (453)c | |
| Ambulance/paramedic services | 72 (696) | 25 (532)c | 311 (3,168) | 99 (1,035)c | 56 (400) | 29 (347)c | |
| Other | 12,039 (35,342) | 4,072 (16,048)c | 17,594 (55,004) | 7,103 (25,388)c | 4,430 (12,517) | 3,407 (13,617)c | |
| Pharmacy costsb | 2,861 (9,012) | 1,683 (6,418)c | 4,807 (9,143) | 3,030 (7,005)c | 2,309 (7,164) | 1,654 (12,880)c | |
| Opioid prescriptionsb | 106 (385) | 13 (42)c | 112 (321) | 6 (45)c | 95 (480) | 9 (72)c | |
| Nonopioid prescriptions | 2,755 (8,986) | 1,670 (6,417)c | 4,695 (9,120) | 3,024 (7,003)c | 2,214 (7,109) | 1,644 (12,879)c | |
| Total health care costsb | 19,696 (46,817) | 7,272 (21,203)c | 30,900 (66,916) | 13,487 (32,412)c | 9,958 (23,230) | 6,581 (23,504)c | |
aExcludes the index date.
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.
cP < 0.001, new persistent opioid use versus no persistent opioid use.
HCPCS = Healthcare Common Procedure Coding System; MMEs = morphine milligram equivalents.