title: Costs of substance use disorders from claims data for Medicare recipients from a population-based sample.
abstract: Medicare spending is projected to increase over the next decade, including for substance use disorders (SUD). Our objective was to determine whether SUDs are associated with higher six-year Medicare costs (1999-2004) among participants in the Baltimore Epidemiologic Catchment Area (ECA) Study. Medicare claims data for the years 1999-2004 from the Centers for Medicare and Medicaid Services were linked to four waves of data from the Baltimore ECA cohort collected between 1981 and 2005 (n=566). A generalized linear model with a log link and gamma distribution was used to examine direct Medicare costs associated with SUD status. Medicare recipients with no history of SUD had mean six-year costs of $42,576. Those with a history of SUD based on both Baltimore ECA and Medicare data, or based on Medicare claims data alone, had significantly higher costs ($98,754 and $64,876, respectively). A history of SUD based solely on Baltimore ECA data alone had lower average costs ($25,491). Findings indicate that Medicare costs differ by source of SUD diagnosis when comparing treatment versus survey data. This may have future implications for projecting Medicare costs among SUD individuals as healthcare coverage expands under the Affordable Care Act.
authors.affiliation: Health Behavior Branch, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA. Electronic address: brian.fairman@nih.gov.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Fairman
authors.affiliation: Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Seungyoung
authors.initials: S
authors.lastname: Hwang
authors.affiliation: Department of Management, Florida Atlantic University College of Business, Boca Raton, FL, USA.
authors.forename: Pierre K
authors.initials: PK
authors.lastname: Alexandre
authors.affiliation: Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gallo
authors.affiliation: Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Eaton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D016014:Linear Models; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D019966:Substance-Related Disorders / Q000191:economics*; D014481:United States
keywords: Alcohol; Medical costs; Medicare; Substance use disorder