Differences in Healthcare Utilization and Associated Costs Between Patients Prescribed vs. Nonprescribed Opioids During an Inpatient or Emergency Department Visit

Abstract

Objectives Compare healthcare resource utilization ( HCRU ) and costs between patients prescribed opioids ( R x OP ) and those who were not ( N o R x OP ) during an emergency department ( ED ) or inpatient visit. Methods Retrospective cohort analysis was performed ( J anuary 2006 to S eptember 2010). Continuously eligible R x OP patients in ED /inpatient settings ( J anuary 2007 to S eptember 2009) were included if age was ≥ 12 years by initial prescription date (or random date between first ED /inpatient admission and S eptember 30, 2009 [ N oRx OP patients]). Healthcare resource utilization and costs for 12 months after initial prescription were compared. Univariate descriptive analyses were performed for baseline and outcome variables and compared using appropriate tests. Risk adjustment compared HCRU between R x OP and N o R x OP cohorts for the postindex period. Results Of 27,599 eligible patients, R x OP patients ( n = 18,819) were younger, less likely to be male, more likely to reside in southern U nited S tates and to have Preferred Provider Organization health plans, and had lower comorbidity index scores, compared with N o R x OP patients ( n = 8,780). R x OP patients were less likely to have nonpain‐related comorbidities and more frequently diagnosed with pain‐related comorbidities. Unmatched and propensity‐matched R x OP patients experienced higher HCRU and costs in all subcategories (total, inpatient, outpatient ED , physician, pharmacy, other outpatient settings). Opioid abuse frequency was low in patients with common diagnoses/procedures within 3 months before initial prescription (0.48%). Average time to abuse was < 1 year (201 days). Conclusion Most patients were prescribed opioids initially during ED /inpatient visits and incurred higher HCRU than those not prescribed opioids. Among those with diagnosed opioid abuse after initiating opioids, time to diagnosis was rapid (range: 14 to 260 days) for patients with common diseases and procedures.