title: Characterizing downstream healthcare resource utilization and costs based on prior utilization patterns of immediate-release hydrocodone.
abstract: OBJECTIVE
  To assess downstream healthcare resource utilization (HRU) and costs among immediate release (IR) hydrocodone patients by days' supply and average doses/month in the prior 6 months.
  
  
  METHODS
  Retrospective analysis using healthcare claims from Truven MarketScan commercial, Medicare supplemental, and Medicaid multistate databases was performed. Patients prescribed IR hydrocodone during the 6-month baseline (July-December 2011), and with continuous enrollment during baseline and the 12-month follow-up (2012) were selected. HRU and per-patient-per-month (PPPM) costs (2014 US dollars) were assessed at follow-up. Descriptive analyses and multivariate regressions were conducted to compare HRU and costs at follow-up by days' supply (<60 vs ≥60 days) and average doses per month (≤60 vs >60 doses/month) of IR hydrocodone at baseline.
  
  
  RESULTS
  In total, 1,698,845 commercial, 264,038 Medicare, and 151,063 Medicaid IR hydrocodone patients were identified. During follow-up, commercial patients with prior ≥60 days' supply were more likely to have an inpatient admission (13.2% vs 7.5%), outpatient hospital visit (69.1% vs 57.0%), office visit (97.6% vs 91.0%), emergency room (ER) visit (28.1% vs 21.4%), and had higher PPPM total costs ($1494 vs $842) than the <60 days' supply sub-group (all p < 0.05). Among commercial patients the adjusted odds ratio for prior ≥60 days' supply of IR hydrocodone vs prior <60 days' supply was 1.62 (inpatient), 1.33 (outpatient), 2.58 (office visit) and 1.48 (ER) (all p-values <0.05). Adjusted all-cause total costs were higher ($1245 vs $851, p <0.05) among commercial patients with longer days' supply than those with shorter days' supply. Trends were similar with ≤60 vs >60 doses per month sub-groups and across all plan types.
  
  
  CONCLUSIONS
  Increased days' supply and higher doses/month of IR hydrocodone in the prior 6 months may help to predict levels of HRU and costs in the following year, providing an opportunity to identify patients in order to implement interventions to improve their quality of care.
authors.affiliation: a a Purdue Pharma L.P. , Stamford , CT , USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Ben-Joseph
authors.affiliation: a a Purdue Pharma L.P. , Stamford , CT , USA.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Bell
authors.affiliation: b b Evidera , Lexington , MA , USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Chitnis
authors.affiliation: b b Evidera , Lexington , MA , USA.
authors.forename: Anuraag
authors.initials: A
authors.lastname: Kansal
authors.affiliation: a a Purdue Pharma L.P. , Stamford , CT , USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Holly
authors.affiliation: b b Evidera , Lexington , MA , USA.
authors.forename: Clark
authors.initials: C
authors.lastname: Paramore
authors.affiliation: c c MedImpact Healthcare Systems, Inc , San Diego , CA , USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Wild
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage*; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States
chemical_list: D006853:Hydrocodone
keywords: Costs; Healthcare resource utilization; Hydrocodone; Retrospective database