Predictors and subsequent healthcare utilization associated with CDC-guideline opioid thresholds among commercially insured new chronic opioid users
dc.contributor.author | Calabrese, Martin Joseph | |
dc.date.accessioned | 2022-06-15T13:47:32Z | |
dc.date.available | 2022-06-15T13:47:32Z | |
dc.date.issued | 2022 | |
dc.identifier.uri | http://hdl.handle.net/10713/19173 | |
dc.description | University of Maryland, Baltimore. Pharmacoeconomics. Ph.D. 2022. | en_US |
dc.description.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. | en_US |
dc.language.iso | en_US | en_US |
dc.subject.mesh | Analgesics, Opioid | en_US |
dc.subject.mesh | MME | en_US |
dc.subject.mesh | Patient Acceptance of Health Care | en_US |
dc.subject.mesh | Outcome Assessment, Health Care | en_US |
dc.subject.mesh | Morphine Derivatives | en_US |
dc.subject.mesh | Centers for Disease Control and Prevention, U.S. | en_US |
dc.title | Predictors and subsequent healthcare utilization associated with CDC-guideline opioid thresholds among commercially insured new chronic opioid users | en_US |
dc.type | dissertation | en_US |
dc.date.updated | 2022-06-10T22:13:06Z | |
dc.language.rfc3066 | en | |
dc.contributor.advisor | Shaya, Fadia T. | |
dc.contributor.orcid | 0000-0003-4304-396X |