title: Estimates of charges associated with emergency department and hospital inpatient care for opioid abuse-related events.
abstract: The economic burden of prescription opioid abuse is substantial; however, no study has estimated the monetary burden of hospital services (emergency department [ED] and inpatient) using a single, nationally representative database. We sought to estimate total and average (adjusted for demographic and clinical factors) charges billed for opioid abuse-related events, and magnitude of difference in charges between ED visits resulting in inpatient admission to the same hospital and treat-and-release ED visits in the United States. We used the 2006, 2007, and 2008 files of the Healthcare Cost and Utilization Project's Nationwide Emergency Departments Sample (HCUP-NEDS) to identify events and charges assigned opioid abuse, dependence, or poisoning ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) diagnosis codes (304.0X, 304.7X, 305.5X, 965.00, 965.02, 965.09). Using methods to account for the complex sampling design of the NEDS and a log-linked gamma regression model, we estimated national total and mean charges (in 2010 USD). Total charges were $9.8, $9.6, and $9.5 billion for 2006, 2007, and 2008, respectively. Medicaid-covered events had the highest total charges ($3 billion), followed by events covered by Medicare ($2 billion) for each year. The national estimate of adjusted, mean, per-event charges, was $18,891 (95% confidence interval [CI] = $18,167-$19,616). Compared with events covered by private insurance, mean charges for Medicare- and Medicaid-covered events were higher (t = 28.14, P < .001; t = 6.42, P < .001, respectively), whereas self-paid events had significantly lower charges (t = -11.14, P < .001). ED visits resulting in subsequent inpatient admission had approximately 6 times higher charges than treat-and-release visits. This study provides estimates of differences in hospital costs of opioid abuse by insurance status, resulting in a better understanding of the economic burden of opioid abuse on the health care system.
authors.affiliation: University of Texas at Austin College of Pharmacy, Austin, Texas, USA. chandwanihitesh@utexas.edu
authors.forename: Hitesh S
authors.initials: HS
authors.lastname: Chandwani
authors.forename: Scott A
authors.initials: SA
authors.lastname: Strassels
authors.forename: Karen L
authors.initials: KL
authors.lastname: Rascati
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Lawson
authors.forename: James P
authors.initials: JP
authors.lastname: Wilson
mesh_terms: D000328:Adult; D017281:Cost of Illness; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D009293:Opioid-Related Disorders / Q000150:complications / Q000191:economics*; D010343:Patient Admission; D012044:Regression Analysis; D014481:United States