High-Cost Patients With Opioid Abuse Share Common Characteristics

High-cost patients diagnosed with opioid abuse have higher rates of chronic comorbidities and mental health conditions compared with lower-cost patients, which highlights the need to consider the complete medical and psychosocial patient history, according to a new study published in the Journal of Managed Care & Specialty Pharmacy.

The researchers used retrospective claims data to describe the characteristics of patients diagnosed with opioid abuse who also have disproportionately high healthcare costs for the purpose of assisting providers in targeting interventions at these costly patients. The study period included a 12-month observation period centered on the date of first opioid abuse diagnosis.

“An improved understanding of these costly patients is relevant for physicians, managed care organizations, and other stakeholders who have an interest in addressing opioid abuse and reducing the associated health care costs,” the authors wrote.

The patients in the top 20% of total healthcare costs among patients diagnosed with opioid abuse were considered “high-cost patients”—they accounted for two-thirds of costs—while the remaining 80% of patients were considered “lower-cost patients.”

High-cost patients were older, more likely to be female, and had a higher comorbidity burden as well as higher rates of conditions such as chronic pulmonary disease and mild or moderate diabetes. They also had higher rates of psychotic disorders.

During the observation period, the mean cost for high-cost patients was $89,177 compared with $11,653 for lower-cost patients. High-cost patients not only were more likely to use medical resources, but they did so with greater intensity. So not only were they more likely to have at least 1 inpatient visit, but they had longer inpatient stays.

The authors recommended that future research examine high-cost patients with opioid abuse in Medicaid, Medicare, and the uninsured population.

“In addition to targeting the subset of patients that accounts for a disproportionate share of the economic burden of opioid abuse, other multifaceted efforts, such as provider education, coordinated programs that address medical and social needs, prescription drug monitoring programs, and new drug formulations intended to deter opioid abuse, may be necessary to address prescription opioid abuse at the societal level,” the researchers concluded.