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P-026 - An Evaluation of the Incidence of Opioid Use Disorder Among People with Acute and Chronic Pain Managed with Prescription Opioids and the Associated Economic and Societal Burden in the United States

POSTER ABSTRACT
Location:  Exhibit Hall
Abstract Title: An Evaluation of the Incidence of Opioid Use Disorder Among People with Acute and Chronic Pain Managed with Prescription Opioids and the Associated Economic and Societal Burden in the United States




Background: Pain is one of the most common reasons Americans seek medical care and is associated with substantial downstream economic burden and patient morbidity. Opioids are a common medication prescribed for the management of acute and chronic pain in the United States (US) due to their perceived efficacy.1 However, opioids have serious risks, including the increased potential for sustained prescription opioid use, abuse, and development of opioid use disorder (OUD). Patients diagnosed with OUD are known to experience increased levels of healthcare resource utilization (HCRU), absenteeism, lost productivity, and mortality, as well as a reduced quality of life. In 2017 alone, the direct and indirect economic burden of OUD ($471 billion [B]) and fatal opioid overdose ($550B) due to prescription and illicit opioids totaled $1.02 trillion, with a majority of the burden due to reduced quality of life and the value of life lost.2 Despite governmental and institutional efforts to reduce opioid prescribing behavior in the last decade, opioids remain widely prescribed.

Purpose/Objectives: While the burden of OUD has been characterized to some degree, there is a lack of understanding on the incidence and economic and societal burden of OUD arising specifically from the use of prescription opioids. We sought to evaluate the incidence of OUD among patients managing acute and chronic pain with prescription opioids in the US. We also aimed to assess the all-cause HCRU and associated costs among prescription opioid patients diagnosed with and without OUD. Finally, we analyzed the societal burden in terms of productivity losses among acute and chronic pain patients using prescription opioids who were also diagnosed with and without OUD.


Methods: A retrospective, longitudinal, observational study was conducted using the Merative® MarketScan® Commercial, Medicare, and Health and Productivity Management Datasets [1/1/2015-12/31/2019 (“Study period”)] to identify adult patients who were newly initiating opioids between 1/1/2016 and 12/31/2018 (first prescription date = opioid initiation date) and without a diagnosis for OUD in the year prior to opioid initiation date. Patients with ≥3 months of continuous or recurrent use of prescription pain medication within a year of the opioid initiation were classified as chronic pain patients, while those with < 3 months were classified as acute pain patients. Subgroups of patients diagnosed with and without OUD were identified via the presence/absence of International Classification of Diseases, Tenth Revision diagnosis codes between the first opioid initiation date and 12/31/2019. The incidence of OUD was evaluated from the opioid initiation date through the earlier of disenrollment or end of the study period. All-cause HCRU and associated direct healthcare costs, and productivity losses (workplace absence and short-term disability) were evaluated for a fixed 12-month period following an OUD diagnosis (or a randomly assigned date for patients without OUD diagnosis). Costs were extrapolated to national-level estimates using standardized statistical techniques based on age and sex.


Results: Among the 2,690,756 patients newly treated with prescription opioids for acute pain identified in the database, 9,955 (0.4%) were diagnosed with OUD and 2,680,801 (99.6%) without OUD diagnosis. Among the 605,019 patients newly treated with prescription opioids for chronic pain identified, 10,262 (1.7%) were diagnosed with OUD and 594,757 (98.3%) without OUD diagnosis. The 1-, 2-, and 3-year incidence rates of OUD among patients receiving prescription opioids for acute pain were 0.21%, 0.32%, and 0.43%, respectively. Among those with chronic pain who received a prescription opioid, the 1-, 2-, and 3-year incidence rates of OUD were 1.11%, 1.52%, and 1.92%, respectively. The mean number of days from initial receipt of a prescription opioid to OUD diagnosis was 353 for acute pain patients and 307 for chronic pain patients.

Among the patient population treated with prescription opioids, those diagnosed with OUD had consistently higher HCRU than those without OUD across both inpatient and outpatient healthcare settings. The corresponding total all-cause cost per patient over the 1-year period for patients diagnosed with OUD was $22,593 greater than those without OUD among acute pain patients (with OUD $33,409 vs. without OUD $10,816) and was $25,959 greater among chronic pain patients (with OUD $50,882 vs. without OUD $24,923). When extrapolated to the national level, the estimated total all-cause costs in the 1-year post OUD diagnosis among patients diagnosed with OUD were $3.1B among acute pain patients and $5.4B among chronic pain patients, totaling $8.5B across both acute and chronic pain patients.

When evaluating work productivity, patients diagnosed with OUD reported a 39% increase in hours lost due to workplace absence compared to those without OUD (with OUD 407 hours; without OUD 293 hours) in the acute pain population, and a 34% increase (with OUD 460 hours, without OUD 344 hours) among those with chronic pain. The days lost due to short-term disability among patients diagnosed with OUD increased by 37% for individuals with acute pain (with OUD 52 days; without OUD 38 days) and by 23% in those with chronic pain (with OUD 64 days, without OUD 52 days).

Conclusions/Implications for future research and/or clinical care: Recent publications indicate that among the 80 million (M) people receiving acute pain medication per year, 50% receive prescription opioids, and among the 25M people receiving chronic pain medication, 45% receive prescription opioids.1 Our findings suggest that ~85,000 patients with acute pain will develop OUD within 1 year of opioid exposure. Cumulatively, this increases to ~128,000 within 2 years and ~172,000 within 3 years. Similarly, for those with chronic pain, ~125,000 people will develop OUD within 1 year, increasing to ~171,000 within 2 years, and ~216,000 by 3 years. The economic impact of OUD developed as a result of exposure to prescription opioids is substantial (~$8.5B) within a year of diagnosis. Productivity losses and disability further increase the economic and societal burden of this condition. Further investment in effective non-opioid treatment options for pain management may help reduce the incidence of OUD and its burden on the healthcare system.


References: 1. Lopez A, et al., An Evaluation of the Prevalence of Acute and Chronic Pain Medication Use in the United States: a Real world Database Analysis. Presented at ASRA Pain Medicine Meeting, New Orleans, LA, November 10-11, 2023
2. Florence C, Luo F, Rice K. The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017. Drug Alcohol Depend. 2021;218:108350. doi:10.1016/j.drugalcdep.2020.108350