title: The Economic Burden of Opioid Abuse: Updated Findings.
abstract: BACKGROUND
  Opioid pain relievers can be highly effective in providing relief for patients suffering from pain. At the same time, prescription opioid abuse, dependence, overdose, and poisoning (hereinafter "abuse") have become a national public health concern. Opioid abuse is also costly: previous estimates of the annual excess costs of opioid abuse to payers range from approximately $10,000 to $20,000 per patient.
  
  
  OBJECTIVE
  To (a) provide a comprehensive, current estimate of the economic burden of opioid abuse to commercial payers and (b) explore the drivers of these excess costs of abuse.
  
  
  METHODS
  Administrative claims from beneficiaries covered by large self-insured companies throughout the United States were used to identify patients diagnosed with opioid abuse, dependence, and overdose/poisoning ("abuse") between 2012 and 2015. Sample selection criteria identified patients most likely to be misusing opioids. Abusers and nonabuser controls were matched using propensity scores. Excess health care costs were assessed over the 18-month study period. Drivers of excess costs were then evaluated by place of service and medical condition (identified as 3-digit ICD-9-CM groupings).
  
  
  RESULTS
  9,342 matched abuser/nonabuser pairs were analyzed. Relative to nonabusers, abusers had significantly higher annual health care resource utilization, leading to $14,810 in per-patient incremental annual health care costs. Excess costs began accumulating 5 months before the formal, incident diagnosis of abuse, driven by alcohol and nonopioid substance abuse. Major drivers of excess costs of abuse included opioid and other substance abuse disorders, mental health conditions, and painful conditions. Many patients had diagnoses for other substance abuse that predated their opioid abuse diagnoses.
  
  
  CONCLUSIONS
  Opioid abuse imposes a substantial economic burden on payers and often occurs in the context of other substance abuse. Poly-substance abuse often precedes the diagnosis of opioid abuse.
  
  
  BACKGROUND
  This study was funded by Purdue Pharma. Mayne is an employee of Purdue Pharma. Kirson, Scarpati, and Birnbaum are employees of Analysis Group, which received funding from Purdue Pharma to conduct this study. Enloe and Dincer were employees of Analysis Group at the time this research was conducted. Study concept and design were contributed by Kirson, Birnbaum, Mayne, and Scarpati, along with Enloe and Dincer. Enloe and Dincer took the lead in data collection, along with Birnbaum and assisted by Kirson and Scarpati. Data interpretation was performed by all the authors. The manuscript was written and revised by Kirson and Scarpati, along with Mayne and Birnbaum.
authors.affiliation: 1 Analysis Group, Boston, Massachusetts.
authors.forename: Noam Y
authors.initials: NY
authors.lastname: Kirson
authors.affiliation: 1 Analysis Group, Boston, Massachusetts.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Scarpati
authors.affiliation: 1 Analysis Group, Boston, Massachusetts.
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Enloe
authors.affiliation: 1 Analysis Group, Boston, Massachusetts.
authors.forename: Aliya P
authors.initials: AP
authors.lastname: Dincer
authors.affiliation: 1 Analysis Group, Boston, Massachusetts.
authors.forename: Howard G
authors.initials: HG
authors.lastname: Birnbaum
authors.affiliation: 2 Purdue Pharma, Stamford, Connecticut.
authors.forename: Tracy J
authors.initials: TJ
authors.lastname: Mayne
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000191:economics*; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000191:economics* / Q000453:epidemiology; D057216:Propensity Score; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications / Q000191:economics; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid