Medical costs for substance use disorders in US employer-sponsored insurance population exceed $35 billion

Researchers were able to quantify the annual medical costs of substance use disorders (SUDs) in patients with employer-sponsored insurance (ESI), according to researchers in a study published in JAMA network open. Investigators used recent financial transactions—the total inpatient, outpatient, and outpatient drug expenditures of ESI registrants with SUD—to estimate that private insurers paid a total of $1.1 trillion in personal healthcare expenses in the United States in 2018.

“Among ESI participants with SUD, this analysis expands knowledge about attributable costs in the ESI population,” the study authors wrote in a recent article. “Strategies to support employees and their health plan members in the prevention and treatment of SUDs can be considered with a view to potentially offsetting the existing high medical costs of SUDs.”

From 2001 to 2020, over 90% of deaths from drug or alcohol poisoning occurred in people aged 20 to 64. As of 2020, 11% of U.S. adult workers reported having SUD, with more than 50% of medium-sized employers reporting that opioids interfered with their workplace.

The aim of the study was to understand how workplaces are affected by SUDs. They performed an economic assessment from a healthcare payer perspective and estimated the applicable annual medical costs of SUDs in the ESI population.

The primary endpoint looked at the annual total medical costs for SUD in the ESI population and the annual medical costs for SUD by substance type in the ESI population. The investigators also reported the average annual cost per diagnosed SUD and the annual average cost per affected participant by substance type.

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Investigators studied 162 million non-Medicare ESI enrollments from the Merative MarketSacan 2018 databases. The team used different types of modeling to calculate medical expenses and compared expenses between participants with and without a SUD diagnosis.

In 2018, the annual attributable medical costs of 1.4% (2.3 million) of ESI participants diagnosed with SUD was US$35.3 billion. The most costly was alcohol use disorder, which contributed $10.2 billion to total annual medical costs. Patients with an opioid use disorder also contributed $7.3 billion to total annual medical costs.

“More than half of those enrolled with a SUD diagnosis had an alcohol-related disorder and almost 30% had an opioid-related disorder,” the investigators wrote in the article.

Alcohol- and opioid-related disorders were associated with high median inpatient costs of $3,988 and $3,570 per enroller, respectively. Mean outpatient costs were $4,875 and $6,280, respectively, and mean total costs per patient were $8,939 and $11,871, respectively.

The data also led investigators to believe that employers and health insurance companies paid medical costs that were higher than those reported in the study. This was based on results showing that 1% of the ESI population was diagnosed with SUD, although 11% of workers self-reported having SUD.

The course is not without limitations. First, the reported cost estimate covers those with insurance but not those with self-pay services. Additionally, they could not accurately match participants for specific comorbidities, nor did they use weighted regression analysis or assess SUD costs among different demographic characteristics in a subgroup analysis.

“Employers can take action by developing workplace-based prevention, treatment and recovery programs,” the study authors write in their analysis.

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Roberts T, Kesselheim A, Avorn J. Variation in the use of targeted therapies for lung cancer in state Medicaid programs, 2020-2021. JAMA network open. 2023;6(1):e2252562. doi:10.1001/jamanetworkopen.2022.52562