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2023 HSR&D/QUERI National Conference Abstract

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1133 — Healthcare costs and utilization before and after opioid overdose in Veterans with opioid use disorder

Lead/Presenter: Vilija Joyce,  Resource Center - HERC
All Authors: Joyce VR (VA HSR&D Health Economics Resource Center, US Department of Veterans Affairs, VA Palo Alto Health Care System, Menlo Park, CA), Oliva EM (VA HSR&D Center for Innovation to Implementation, US Department of Veterans Affairs, VA Palo Alto Health Care System, Menlo Park, CA) Garcia C (VA HSR&D Health Economics Resource Center, US Department of Veterans Affairs, VA Palo Alto Health Care System, Menlo Park, CA) Trafton J (Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA; VA Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, VA Central Office, US Department of Veterans Affairs, Palo Alto, CA) Asch SM (VA HSR&D Center for Innovation to Implementation, US Department of Veterans Affairs, VA Palo Alto Health Care System, Menlo Park, CA; Department of Medicine, Stanford University, Stanford, CA) Wagner T (VA HSR&D Health Economics Resource Center, US Department of Veterans Affairs, VA Palo Alto Health Care System, Menlo Park, CA) Humphreys K (VA HSR&D Center for Innovation to Implementation, US Department of Veterans Affairs, VA Palo Alto Health Care System, Menlo Park, CA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA) Owens DK (Stanford Health Policy, Department of Health Policy, Stanford University, Stanford, CA) Bounthavong M (VA HSR&D Health Economics Resource Center, US Department of Veterans Affairs, VA Palo Alto Health Care System, Menlo Park, CA)

Objectives:
Veterans are over-represented among the 79,000 opioid-involved overdose deaths in the United States in 2021 due to the prevalence of risk factors such as chronic pain, major depression, and post-traumatic stress disorder, and being male. The utilization and economic burden of responding to this crisis in VA has never been calculated. We therefore estimated healthcare utilization and costs associated with opioid-related overdose among Veterans with opioid use disorder.

Methods:
For our retrospective cohort study of VA administrative and clinical data, we included patients diagnosed with OUD from October 1, 2017 through September 30, 2018 (FY18). OUD was defined by International Classification of Diseases (ICD-10-CM) F11 code. The index date was the date of the first overdose that occurred in FY18. We excluded patients who had an overdose within the previous 360 days as well as those with cancer or who were receiving palliative or hospice care. Our control group included patients with OUD who did not have an overdose. Among controls, we randomly assigned patients an index date and applied the same 360-day washout criteria. We used generalized estimating equation models to compare the two groups using a difference-in-differences framework. Subgroup analyses were performed on patients who experienced multiple overdoses.

Results:
An opioid overdose was associated with an increase of $17,387 in the overdose cohort (n = 1,636) compared to the non-overdose cohort (n = 65,546) during the month of overdose after adjusting for baseline characteristics. Inpatient costs ($14,758) were responsible for most of this increase. Healthcare utilization also increased in the month after opioid overdose in terms of length of inpatient stay (+1.49 days), inpatient admissions (+1.06 admits), and outpatient visits (+1.49 visits). Beginning 3 months prior to the opioid overdose, total costs, inpatient admissions, and outpatient visits were significantly higher among the overdose cohort compared to the non-overdose cohort; within the 12 months after the opioid overdose, healthcare costs and utilization remained higher, on average, compared to pre-overdose trends for the overdose cohort. In subgroup analyses, patients with more than 1 overdose (n = 202) had the most pronounced differences in costs and admissions.

Implications:
Veterans with OUD and opioid-related overdose had increased healthcare costs and utilization in the 3 months preceding the overdose and for at least 12 months afterward.

Impacts:
The opioid epidemic has strained health care resources nationwide and the VA is no exception. This cohort study estimated the costs for Veterans who experienced an opioid related overdose. Stakeholders can use this information when planning strategies to support overdose avoidance efforts.