Healthcare costs and utilization associated with high-risk prescription opioid use: a retrospective cohort study.
Healthcare costs and utilization associated with high-risk prescription opioid use: a retrospective cohort study.
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DOI：
10.1186/s12916-018-1058-y
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发表时间：
2018-05-16
期刊：
影响因子：
9.3
通讯作者：
Alexander GC
中科院分区：
文献类型：
--
作者：
Chang HY;Kharrazi H;Bodycombe D;Weiner JP;Alexander GC
以前关于高风险阿片类药物使用的研究只集中在诊断为阿片类药物障碍的患者身上。这项研究评估了各种高风险处方阿片类药物使用组对医疗费用和利用率的影响。这是一项回顾性队列研究，使用QuintilesIMS健康计划声明，自变量来自2012年，结局来自2013年。我们纳入了191，405名已知性别的非老年人的人群样本，一种或多种阿片类药物处方，并在2012年和2013年连续入组。2012年确定了三个高风险阿片类药物使用组：（1）连续90天每天使用100+吗啡毫克当量的人（慢性使用者）;（2）合并使用阿片类药物和苯二氮卓类药物30天以上的人（合并使用者）;和（3）被诊断患有阿片类药物使用障碍的人。对一个人被定性为高风险用户的时间长度进行了测量。从2013年得出的三项医疗保健成本（总成本、医疗成本和药房成本）和四项二元利用指标（总成本最高的5%用户、药房成本最高的5%用户、任何住院和任何急诊科就诊）是结果。我们采用了广义线性模型（GLM）与对数链接函数和伽玛分布的成本，而逻辑回归利用指标。我们还采用倾向评分加权来控制高风险和非高风险阿片类药物使用者之间的基线差异。在有一种或多种阿片类药物处方的个体中，1.45%是慢性使用者，4.81%是伴随使用者，0.94%被诊断为阿片类药物使用障碍。经过调整和倾向评分加权后，长期使用者的预期总成本（40%）、医疗成本（3%）和药房成本（172%）在统计学上显著较高。与伴随使用者相关的总费用、医疗费用和药房费用的增加分别为13%、7%和41%，诊断为阿片类药物使用障碍的使用者分别为28%、21%和63%。总成本和药房成本都随着高风险用户的时间长度而增加，这种增加具有统计学意义。只有伴随使用者与住院或急诊使用的几率较高相关。高风险处方阿片类药物使用者的医疗保健成本和利用率明显高于同行，特别是那些长期使用高剂量阿片类药物的人。
Previous studies on high-risk opioid use have only focused on patients diagnosed with an opioid disorder. This study evaluates the impact of various high-risk prescription opioid use groups on healthcare costs and utilization. This is a retrospective cohort study using QuintilesIMS health plan claims with independent variables from 2012 and outcomes from 2013. We included a population-based sample of 191,405 non-elderly adults with known sex, one or more opioid prescriptions, and continuous enrollment in 2012 and 2013. Three high-risk opioid use groups were identified in 2012 as (1) persons with 100+ morphine milligram equivalents per day for 90+ consecutive days (chronic users); (2) persons with 30+ days of concomitant opioid and benzodiazepine use (concomitant users); and (3) individuals diagnosed with an opioid use disorder. The length of time that a person had been characterized as a high-risk user was measured. Three healthcare costs (total, medical, and pharmacy costs) and four binary utilization indicators (the top 5% total cost users, the top 5% pharmacy cost users, any hospitalization, and any emergency department visit) derived from 2013 were outcomes. We applied a generalized linear model (GLM) with a log-link function and gamma distribution for costs while logistic regression was employed for utilization indicators. We also adopted propensity score weighting to control for the baseline differences between high-risk and non-high-risk opioid users. Of individuals with one or more opioid prescription, 1.45% were chronic users, 4.81% were concomitant users, and 0.94% were diagnosed as having an opioid use disorder. After adjustment and propensity score weighting, chronic users had statistically significant higher prospective total (40%), medical (3%), and pharmacy (172%) costs. The increases in total, medical, and pharmacy costs associated with concomitant users were 13%, 7%, and 41%, and 28%, 21% and 63% for users with a diagnosed opioid use disorder. Both total and pharmacy costs increased with the length of time characterized as high-risk users, with the increase being statistically significant. Only concomitant users were associated with a higher odds of hospitalization or emergency department use. Individuals with high-risk prescription opioid use have significantly higher healthcare costs and utilization than their counterparts, especially those with chronic high-dose opioid use.
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