Nearly 8% of annual hospital spend treats opioid use disorder

The opioid epidemic has not only taken the lives of nearly 1 million people in the last 24 years, but it has also cost the US healthcare system tens of billions of dollars annually.

The healthcare system spends an estimated $95.4 billion, or 7.9% of all hospital expenditures, related to opioid use disorder (OUD) each year, according to a January analysis from health services firm Premier.

Premier data scientists conducted the analysis using the firm’s database of hospital discharge summaries. They analyzed all discharges for emergency department outpatient visits and inpatient admissions that took place in Q1 2017 and Q1 2022.

The analysis found that 66 million emergency department outpatient visits and 760,000 inpatient admissions annually are for patients with OUD.

And that’s likely an undercount because “opioid use disorder is very frequently underdiagnosed in hospital records,” Noa Krawczyk, an assistant professor of population health at NYU Grossman School of Medicine who specializes in OUD treatment research, told Healthcare Brew.

“It’s really striking how many hospitalizations and health-related costs we’re having related to opioid use disorder,” said Krawczyk.

The costs of treatment

Emergency room visits per OUD patient cost 32.5% more and inpatient visits cost 8% more compared to patients without an OUD diagnosis, the Premier analysis found. And the average outpatient visit for an OUD patient comes out to $1,264, while the average inpatient visit for an OUD patient costs $15,763, the report estimated.

The analysis provides just a snapshot of how much treating OUD costs, though, since it evaluates costs incurred during a hospital stay. Also, the majority of treatment for OUD takes place in an outpatient setting, according to Krawczyk.

Most of the OUD patients in the analysis were enrolled in Medicaid or were uninsured, so the financial burden of treatment for these patients largely fell on health systems. Premier analysts estimated that if the payer mix remained constant across all hospital emergency room and inpatient visits in the nation, $67 billion of the total US annual cost to treat OUD patients in the hospital would fall to Medicare and Medicaid.

Patients with an OUD diagnosis are also more likely to be discharged to either a long-term care facility or law enforcement facility after their hospital visit, which is even more expensive, according to the analysis.

Why is treating patients with OUD so expensive?

One reason is probably how long OUD patients are in the hospital, said Krawczyk. “Because of all the stigma around substance use, there’s really reluctance to, or lack of access to, care,” she said. “That can mean that somebody waits a long time, and doesn’t report an infection early on […] so then when they end up in the hospital, it ends up being a more complex health situation, which requires longer to treat.”

OUD is also a complex disease to treat, and patients can face severe complications.

In a study Krawczyk coauthored, Covid-19 patients with OUD had worse complications than patients without the disorder. OUD patients were more likely to be intubated and experience kidney failure, among other complications, she said.

“It’s really kind of a baseline of already complex healthcare conditions mixed with a very vulnerable population that’s highly stigmatized,” Krawczyk said. “That leads to high healthcare costs.”