title: Estimating the health care burden of prescription opioid abuse in five European countries.
abstract: BACKGROUND
  Opioid abuse, including abuse of prescription opioids ("RxOs") and illicit substances like heroin, is a serious public health issue in Europe. Currently, there is limited data on the magnitude of RxO abuse in Europe, despite increasing public and scientific interest in the issue. The purpose of this study was to use the best-available data to derive comparable estimates of the health care burden of RxO abuse in France, Germany, Italy, Spain, and the United Kingdom (EU5).
  
  
  METHODS
  Published data on the prevalence of problem opioid use and the share of opioid abuse patients reporting misuse of non-heroin opioids were used to estimate the prevalence of RxO abuse in the EU5 countries. The costs of RxO abuse were calculated by applying published estimates of the incremental health care costs of opioid abuse to country-specific estimates of the costs of chronic pain conditions. These estimates were input into an economic model that quantified the health care burden of RxO abuse in each of the EU5 countries. Sensitivity analyses examined key assumptions.
  
  
  RESULTS
  Based on best-available current data, prevalence estimates of RxO abuse ranged from 0.7 to 13.7 per 10,000 individuals across the EU5 countries. Estimates of the incremental health care costs of RxO abuse ranged from €900 to €2,551 per patient per year. The annual health care cost burden of RxO abuse ranged from €6,264 to €279,927 per 100,000 individuals across the EU5 countries.
  
  
  CONCLUSIONS
  This study suggests that RxO abuse imposes a cost burden on health systems in the five largest European countries. The extent of RxO abuse in Europe should be monitored given the potential for change over time. Continued efforts should be made to collect reliable data on the prevalence and costs of RxO abuse in Europe to facilitate an accurate characterization of the extent of this potentially growing problem.
authors.affiliation: Analysis Group, Inc., Boston, MA, USA.
authors.forename: Amie
authors.initials: A
authors.lastname: Shei
authors.affiliation: Mundipharma International Limited, Cambridge, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hirst
authors.affiliation: Analysis Group, Inc., Boston, MA, USA.
authors.forename: Noam Y
authors.initials: NY
authors.lastname: Kirson
authors.affiliation: Analysis Group, Inc., Boston, MA, USA.
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Enloe
authors.affiliation: Analysis Group, Inc., Boston, MA, USA.
authors.forename: Howard G
authors.initials: HG
authors.lastname: Birnbaum
authors.affiliation: Mundipharma International Limited, Cambridge, UK.
authors.forename: William C N
authors.initials: WC
authors.lastname: Dunlop
keywords: abuse; health care costs; prescription opioids; prevalence