Increased Healthcare Utilization and Expenditures Associated With Chronic Opioid Therapy

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.

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).

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.

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.

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