Short-term healthcare resource utilization associated with receipt of CDC-informed opioid thresholds among commercially insured new chronic opioid users

Martin J. Calabrese; Fadia T. Shaya; Francis Palumbo; Mary Lynn McPherson; Ester Villalonga-Olives; Zafar Zafari; Ryan Mutter

doi:10.5055/jom.0848

Authors

Martin J. Calabrese, PharmD, PhD https://orcid.org/0000-0003-4304-396X
Fadia T. Shaya, PhD, MPH
Francis Palumbo, PhD, JD
Mary Lynn McPherson, PharmD, PhD, BCPS
Ester Villalonga-Olives, PhD, MSc
Zafar Zafari, MSc, PhD
Ryan Mutter, PhD

DOI:

https://doi.org/10.5055/jom.0848

Keywords:

chronic opioid use, prescription opioids, healthcare utilization, outcomes

Abstract

Objective: To evaluate the impact of recent changes to the Centers for Disease Control and Prevention (CDC) morphine milligram equivalent (MME)/day threshold recommendations on healthcare utilization.

Design: A retrospective cohort study of new chronic opioid users (NCOUs).

Setting: Commercially insured plans across the United States using IQVIA PharMetrics® Plus for Academics database with new use between January 2014 and March 2015.

Patients: NCOUs with ≥60-day coverage of opioids within a 90-day period with ≥30-day opioid-free period prior to the date of the first qualifying opioid prescription.

Interventions: NCOU categorized by the CDC three-tiered risk-based average MME/day thresholds: low (>0 to <50), medium (≥50 to <90), and high (≥90).

Main outcome measures: Multivariable logistic regression was used to calculate adjusted odds of incurring an acute care encounter (ACE) (all-cause and opioid related) between the thresholds (adjusted odds, 95 percent confidence interval).

Results: In adjusted analyses, when compared to low threshold, there was no difference in the odds of all-cause ACE across the medium (1.01, 0.94-1.28) and high (1.01, 0.84-1.22) thresholds. When compared to low threshold, a statistically insignificant increase was observed when evaluating opioid-related ACE among medium (1.86, 0.86-4.02) and high (1.51, 0.65-3.52) thresholds.

Conclusions: There was no difference in odds of an all-cause or opioid-related ACE associated with the thresholds. Early-intervention programs and policies exploring reduction of MME/day among NCOUs may not result in short-term reduction in all-cause or opioid-related ACEs. Further assessment of potential long-term reduction in ACEs among this cohort may be insightful.

Author Biographies

Martin J. Calabrese, PharmD, PhD

Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy; Center for Medicare, Centers for Medicare & Medicaid Services, Baltimore, Maryland

Fadia T. Shaya, PhD, MPH

Professor, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland

Francis Palumbo, PhD, JD

Professor, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland

Mary Lynn McPherson, PharmD, PhD, BCPS

Professor, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland

Ester Villalonga-Olives, PhD, MSc

Assistant, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland

Zafar Zafari, MSc, PhD

Assistant, Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland

Ryan Mutter, PhD

Congressional Budget Office, Health Analysis Division, Washington, DC

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