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The American Journal of Accountable Care December 2018
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Increased Healthcare Utilization and Expenditures Associated With Chronic Opioid Therapy
Douglas Thornton, PharmD, PhD; Nilanjana Dwibedi, PhD; Virginia Scott, PhD; Charles D. Ponte, PharmD; Xi Tan, PharmD, PhD; Douglas Ziedonis, MD; and Usha Sambamoorthi, PhD
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Increased Healthcare Utilization and Expenditures Associated With Chronic Opioid Therapy

Douglas Thornton, PharmD, PhD; Nilanjana Dwibedi, PhD; Virginia Scott, PhD; Charles D. Ponte, PharmD; Xi Tan, PharmD, PhD; Douglas Ziedonis, MD; and Usha Sambamoorthi, PhD
The increase in healthcare utilization and expenditures associated with the transition to chronic opioid therapy places increased burden on payers and patients.
ABSTRACT

Objectives: To assess the association of the transition from incident opioid use to incident chronic opioid therapy (COT) with the trajectories of healthcare utilization and expenditures.

Study Design: We used a longitudinal, retrospective cohort design, including seven 120-day time periods covering preindex (t1, t2, and t3), index (t4), and postindex (t5, t6, and t7) periods with data from adults aged 28 to 63 years at the index date, without cancer, and continuously enrolled in a primary commercial insurance plan (N = 20,201).

Methods: Multivariable analyses were performed on utilization (population-averaged [PA] logistic regression), expenditures (PA generalized estimating equations), and expenditure estimates (counterfactual prediction). The data used were from a commercial claims database (10% random sample from the IQVIA Real-World Data Adjudicated Claims - US database) from 2006-2015.

Results: Patients on COT were more likely to use inpatient services (adjusted odds ratio, 1.11; 95% CI, 1.01-1.21) compared with those who did not. Although expenditures peaked during the index period (t4) for all users, differences in unadjusted average 120-day expenditures between COT and non-COT users were highest in t4 for total ($4607) and inpatient ($2453) expenditures. COT users had significantly higher total (β = 0.183; P <.01) and inpatient (β = 0.448; P <.001) expenditures.

Conclusions: The period after incident opioid prescription but before transition to COT is an important time for payers to intervene.

The American Journal of Accountable Care. 2018;6(4):11-18

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