Predictors and subsequent healthcare utilization associated with CDC-guideline opioid thresholds among commercially insured new chronic opioid users

Abstract

Background: The receipt and subsequent healthcare utilization surrounding new chronic opioid users (NCOUs) is multifactorial and includes clinical, demographic, and state-level factors. This study evaluated i) predictors for receipt of chronic opioid therapy informed by CDC-guideline morphine milligram equivalent (MME)/day recommendations and the short-term healthcare utilization measured by ii) total healthcare costs and iii) all-cause hospitalization after new chronic opioid use. Methods: We conducted a retrospective cohort study using IQVIA PharMetrics® Plus for Academics commercial claims with NCOUs identified between January 2014 through March 2015. NCOUs were defined as having at least 60-days coverage of opioids within a 90-day period with at least a 30-day opioid-free period prior to the date of the first qualifying opioid prescription. The short-term healthcare observation period began the 91st day or the day after last day coverage of the chronic opioid period, whichever is sooner. We placed NCOUs in one of three-tiered risk-based opioid thresholds categories: low (> 0 to < 50 MME/day), medium (≥ 50 to < 90 MME/day), and high (≥ 90 MME/day). A multinomial logistic regression was used to evaluate the impact of prescription drug monitoring program (PDMP) rigor on the receipt of respective opioid thresholds. A generalized linear model and multivariable logistic regression was utilized to evaluate the incremental total healthcare costs (ITHC) and odds of incurring a hospitalization between the thresholds, respectively. Results: A total of 16,684 NCOUs were identified. Among the NCOUs, a state with high PDMP robustness had lower odds of receiving medium (0.74; 0.62-0.90) and high (0.74; 0.59-0.92) thresholds when compared to low. When compared to low, medium and high were found to have higher ITHC, (US$, 95% Confidence Interval [CI]) $1,429 (947-1,911) and $1,775 (1,183-2,368), respectively. When compared to medium, the ITHC for high $267 (-310-844) was non-significant. When evaluating odds of all-cause hospitalization (adjusted odds; 95% CI), when compared to low, no difference was identified with medium (1.01; 0.94-1.28) or high (1.01; 0.84-1.22). Conclusion: Among NCOUs, PDMP robustness was found to decrease the odds of subsequent receipt of higher thresholds. However, short-term healthcare costs and all-cause hospitalization did not differ among the thresholds.