The opioid public health crisis in Texas: Characterizing real-world healthcare resource utilization and economic burden in different clinical settings
DOI:
https://doi.org/10.5055/jom.0899Keywords:
opioid, abuse, adverse effects, resource utilization, economic burdenAbstract
Background and aims: Given the national opioid public health crisis, this study aimed to characterize the real-world healthcare resource utilization pattern and to quantify the economic burden associated with opioid misuse in Texas.
Methods: A retrospective cross-sectional study was conducted using Texas statewide Inpatient, Outpatient, and Emergency Department (ED) administrative data. International Classification of Diseases, 10th Revision (ICD-10-CM) codes related to opioid abuse, adverse effects, dependence, and poisoning identified opioid-related clinical encounters. High-sensitivity and high-specificity definition criteria were used to capture the range of opioid-related clinical encounters. Descriptive statistics were applied to evaluate the resource utilization and economic burden in different clinical settings and by different types of opioid misuse. Multivariable logistic regression models were applied to identify the association with patients' characteristics.
Results: The high-sensitivity definition identified three to six times more opioid-related clinical encounters related as compared to the high-specificity definition (31,901 vs 10,423 outpatient visits and 47,021 vs 7,444 inpatient visits). A greater proportion of these patients were aged 18-44, White, non-Hispanic, living in metro areas, and uninsured as compared to all-cause visits. EDs were heavily utilized with the outpatient visits predominantly through the ED (>90 percent) and between 49 and 78 percent of inpatient hospitalizations admitted through ED. The multivariable association between patient characteristics and opioid-related clinical encounters varied with clinical settings and the two definitions. High-sensitivity opioid-related clinical encounters were generally associated with higher charges as compared to high-specificity encounters. The total healthcare charge related to opioid misuse in 2016 was estimated to be USD 0.27 billion using the high-specificity definition and USD 2.6 billion using the high-sensitivity definition.
Conclusions: Findings indicate opioid-related clinical encounters impose significant clinical and economic burdens in Texas. Study findings can help healthcare policymakers, professionals, and clinicians better classify opioid use disorder as a major but underreported condition in Texas.
References
Department of Health and Human Services: Determination that a public health emergency exists. 2017. Available at https://www.hhs.gov/sites/default/files/opioid%20phe%20declarationno-sig.pdf. Accessed May 7, 2020.
Substance Abuse and Mental Health Services Administration: Results from the 2018 National Survey on drug use and health: Summary of national findings (HHS publication no. PEP19-5068, NSDUH series). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 2019. Available at https://www.samhsa.gov/data/. Accessed December 5, 2019.
Wilson N, Kariisa M, Seth P, et al.: Drug and opioid-involved overdose deaths—United States, 2017-2018. MMWR Morb Mortal Wkly Rep. 2020; 69(11): 290-297. DOI: 10.15585/mmwr.mm6911a4.
Hedegaard H, Miniño AM, Warner M: Drug overdose deaths in the United States, 1999-2018 (NCHS Data Brief, no 356). Hyattsville, MD: National Center for Health Statistics, 2020. Available at https://www.cdc.gov/nchs/products/databriefs/db356.htm.
Ahmad FB, Rossen LM, Sutton P: Provisional drug overdose death counts. 2020. Available at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm. Accessed May 7, 2020.
Healthcare Cost and Utilization Project (HCUP): HCUP fast stats—Opioid-related hospital use. 2020. Available at https://www.hcup-us.ahrq.gov/faststats/OpioidUseServlet. Accessed May 7, 2020.
Reinhart M, Scarpati LM, Kirson NY, et al.: The economic burden of abuse of prescription opioids: A systematic literature review from 2012 to 2017. Appl Health Econ Health Policy. 2018; 16(5): 609-632. DOI: 10.1007/s40258-018-0402-x.
Kirson NY, Scarpati LM, Enloe CJ, et al.: The economic burden of opioid abuse: Updated findings. J Manag Care Spec Pharm. 2017; 23(4): 427-445. DOI: 10.18553/jmcp.2017.16265.
Segel J, Shi Y, Moran J, et al.: Revenue losses to state and federal government from opioid-related employment reductions. Med Care. 2019; 57(7): 494-497. DOI: 10.1097/MLR.0000000000001107.
Quam L, Ellis LBM, Venus P, et al.: Using claims data for epidemiologic research: The concordance of claims-based criteria with the medical record and patient survey for identifying a hypertensive population. Med Care. 1993; 31(6): 498-507. DOI: 10.1097/00005650-199306000-00003.
Bennett BM: On comparisons of sensitivity, specificity and predictive value of a number of diagnostic procedures. Biometrics. 1972; 28(3): 793-800. DOI: 10.2307/2528763.
Rector TS, Wickstrom SL, Shah M, et al.: Specificity and sensitivity of claims-based algorithms for identifying members of Medicare + choice health plans that have chronic medical conditions. Health Serv Res. 2004; 39(6p1): 1839-1858. DOI: 10.1111/j.1475-6773.2004.00321.x.
Singh JA, Cleveland JD: National US time-trends in opioid use disorder hospitalizations and associated healthcare utilization and mortality. PLoS One. 2020; 15(2): e0229174. DOI: 10.1371/journal.pone.0229174.
Peterson C, Xu L, Mikosz CA, et al.: US hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011–2015. J Subst Abuse Treat. 2018; 92: 35-39. DOI: 10.1016/j.jsat.2018.06.008.
Texas Department of Health and Human Services: Texas outpatient public use data file (PUDF). 2020. Available at https://www.dshs.texas.gov/thcic/outpatientfacilities/outpatientpudf.shtm. Accessed May 7, 2020.
Texas Department of Health and Human Services: Texas inpatient public use data file (PUDF). 2020. Available at https://www.dshs.state.tx.us/thcic/hospitals/inpatientpudf.shtm. Accessed May 7, 2020.
Texas Department of Health and Human Services: Texas emergency department data. Available at https://www.dshs.state.tx.us/thcic/hospitals/inpatientpudf.shtm. Accessed May 7, 2020.
Moore BJ, Barrett ML: Case study: Exploring how opioid-related diagnosis codes translate from ICD-9-CM to ICD-10-CM. 2017. Available at https://www.hcup-us.ahrq.gov/reports/methods/methods.jsp. Accessed May 7, 2020.
US Department of Agriculture: Rural-urban continuum codes. 2017. Available at https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/documentation/. Accessed May 7, 2020.
Centers for Disease Control and Prevention: Drug overdose death rates. 2017. Available at https://www.cdc.gov/drugoverdose/data/statedeaths/drug-overdose-death-2017.html. Accessed May 7, 2020.
National Institute on Drug Abuse: Opioid summaries by state. 2020. Available at https://www.drugabuse.gov/drugsabuse/opioids/opioid-summaries-by-state. Accessed May 7, 2020.
Rajbhandari-Thapa J, Zhang D, Padilla HM, et al.: Opioid-related hospitalization and its association with chronic diseases: Findings from the National Inpatient Sample, 2011-2015. Prev Chronic Dis. 2019; 16: E157. DOI: 10.5888/pcd16.190169.
Salzman M, Jones CW, Rafeq R, et al.: Epidemiology of opioid-related visits to US Emergency Departments, 1999–2013: A retrospective study from the NHAMCS (National Hospital Ambulatory Medical Care Survey). Am J Emerg Med. 2020; 38(1): 23-27. DOI: 10.1016/j.ajem.2019.03.052.
Texas Department of Health and Human Services: Texas health data: Opioid-related emergency department visits. Available at http://healthdata.dshs.texas.gov/dashboard/drugsand-alcohol/opioid-related-emergency-department-visits. Accessed May 2020.
Published
How to Cite
Issue
Section
License
Copyright 2005-2024, Weston Medical Publishing, LLC
All Rights Reserved
