Healthcare Costs Associated with Rates of Prescription Opioid Misuse/Abuse

The opioid crisis has created a significant burden for the US healthcare system. Healthcare costs associated with opioid overdose, intentional misuse/abuse, and dependence are estimated at $35 billion per year¹. Countless initiatives have aimed to reduce these costs through institutional/local/state policy, patient and provider education, increased access to substance use disorder treatment, availability of an opioid overdose reversal agent (naloxone), decreased access to prescription opioid medications, and development of opioid medications with abuse deterrent properties. Abuse deterrent formulations (ADFs) are intended to deter abuse, particularly via non-oral routes (snorting, injecting) which are associated with significantly higher risk of a life-threatening event or death². Recent studies have demonstrated reduced risk of nonoral use with ADF medications compared to non-ADF opioids^3-6. These rates have yet to be translated into healthcare cost estimates.

Purpose/Objectives:

The study purpose was to estimate and compare healthcare costs associated with intentional misuse/abuse exposures among four different groups of prescription opioids (XTAMPZA ER, other ER oxycodone, other ER opioids for analgesia, and IR oxycodone) by utilizing clinical outcome data from the National Poison Data System (NPDS) and healthcare cost data from the Healthcare Cost and Utilization Project (HCUP). XTAMPZA ER is an ER oxycodone medication with ADF labeling. All other ER oxycodone products are also ADF medications but use a different technology/platform than XTAMPZA ER. The other ER opioids for analgesia and IR oxycodone groups are comprised almost exclusively of non-ADF medications. Outcomes based analyses that evaluate ADF products are critical to measure the potential impact in reduction of intentional misuse/abuse and related healthcare costs.

Method:

Rates of exposures that resulted in hospital admission and rate ratios (RR) (using XTAMPZA ER as the reference medication) were calculated for each study group using NPDS data (01January2019 - 31December2022) and adjusted per 100,000 US population using US Census data. HCUP estimates from 2020 (most recent data available) were used to extrapolate an estimated cost for opioid-related hospital admissions (cost per admission $20,706 USD, 95% CI $19,484-$21,928). These extrapolated estimated costs were then compared between study groups.

Results:

Rates of intentional misuse/abuse cases resulting in hospital admission per 100,000 US population were 0.17 (95%CI 0.02-0.33) for XTAMPZA ER, 7.10 (95%CI 6.13-8.08; RR 40.6, 95%CI 16.7-98.6) for other ER oxycodone, 3.53 (95%CI 2.85-4.22; RR 20.2, 95%CI 8.2-49.6) for other ER opioids for analgesia, and 55.65 (95%CI 52.91-58.38; RR 318.0, 95%CI 132.2-765.1) for IR oxycodone. Extrapolated estimated costs of hospital admission involving intentional misuse/abuse during the study period were $3,623 (95%CI $3,409-$3,837) for XTAMPZA ER, $147,107 (95%CI $138,425-$155,789) for other ER oxycodone, $73,191 (95%CI $68,871-$77,511) for other ER opioids for analgesia, and $1,152,219 (95%CI $1,084,219-$1,220,219) for IR oxycodone.

Conclusions: This study found that intentional misuse/abuse exposures to XTAMPZA ER (an ADF ER oxycodone medication) resulted in significantly fewer hospital admissions and lower hospital admission costs than other ER oxycodone, other ER opioids for analgesia, and IR oxycodone. Exposures to XTAMPZA ER were 40-318 times less likely to result in a hospital admission and therefore the estimated healthcare cost was orders of magnitude less than exposures to the other three study groups. Consistent with previous reports, incorporating ADF opioid medications may help reduce the community based public health risks of opioid misuse/abuse and associated healthcare costs. While ADF opioid medications have limitations, they can support incremental progress toward mitigating opioid misuse/abuse.

References: 1High Price of the Opioid Crisis, 2021. Pew Charitable Trusts, Aug 2021. https://www.pewtrusts.org/-/media/assets/2021/09/highpriceofopioidcrisis_infographic_2021_final.pdf accessed 15 June 2023.
2Green JL, Bucher Bartelson B, Le Lait MC, Roland CL, Masters ET, Mardekian J, Bailey JE, Dart RC (2017). Medical outcomes associated with prescription opioid abuse via oral and non-oral routes of administration. Drug Alc Dependence. 175, 140-145. https://doi.org//10.1016/j.drugalcdep.2017.01.039
3Green JL, Robbins RS, Dailey-Govoni T, Butler SF (2021). Nonmedical use of Xtampza® ER and other oxycodone medications in adults evaluated for substance abuse treatment: real-world data from the Addiction Severity Index-Multimedia Version (ASI-MV®). Journal of Pain Research. 14:1773-1783. https://doi.org/10.2147/JPR.S304805
4Severtson SG, Kreider SED, Amioka EC, Margolin ZR, Iwanicki JL, Dart RC (2020). Postmarketing analysis of misuse, abuse, and diversion of Xtampza ER. Pain Med. 21(12), 3660-3668. https://doi.org/10.1093/pm/pnaa272
5Severtson SG, Ellis MS, Kurtz SP, Rosenblum A, Cicero TJ, Parrino MW, Gilbert MK, Buttram ME, Dasgupta N, Bucher Bartelson B, Green JL, Dart RC (2016). Sustained reduction of diversion and abuse after introduction of an abuse deterrent formulation of extended release oxycodone. Drug & Alcohol Dependence. 168, 219-229. http://doi.org/10.1016/j.drugalcdep.2016.09.018
6Rodriguez RD, Dailey Govoni T, Rajagopal V, Green JL. Evaluating the effectiveness of reformulated extended-release oxycodone with abuse-deterrent properties on reducing non-oral abuse among individuals assessed for substance abuse treatment with the Addiction Severity Index-Multimedia Version (ASI-MV). Current Medical Research and Opinion 2023. http://doi.org/10.1080/03007995.2023.2178080