Opioid use disorder (OUD) may have added $10.8 billion to the cost of treating commercially insured patients across the United States in 2016. Many patients with OUD have complex healthcare needs, contributing to their significant healthcare costs.
Excess costs for individuals with OUD and comorbid chronic medical conditions represent a significant value opportunity for potential reductions through targeted treatment strategies. Previous Milliman studies have found that most of the excess healthcare costs for patients with behavioral and chronic comorbidities result from increased medical treatment rather than directly from higher utilization of behavioral services. A new analysis by Milliman actuaries found a similar result for patients with OUD: over half of the excess costs for these comorbid patients were spent on physical healthcare services.
Although the OUD and long-term opioid user population make up only 1.5% of the total population, they account for over 80% of the total opioid spent among the commercially insured population in the U.S. The remaining 98.5% of the population accounts for only 20% of the prescription opioid expenditures.
Due to the complexity of health status for patients with OUD and elevated opioid use, there is no simple treatment solution that works for all patients. In this paper, Milliman’s Katie Matthews and Ally Weaver discuss in more detail items to be considered when it comes to OUD, including costs, utilization, and comorbidities.