Characterizing downstream healthcare resource utilization and costs based on prior utilization patterns of immediate-release hydrocodone

Abstract

Objective:

To assess downstream healthcare resource utilization (HRU) and costs among immediate release (IR) hydrocodone patients by days’ supply and average doses/month in the prior 6 months.

Methods:

Retrospective analysis using healthcare claims from Truven MarketScan commercial, Medicare supplemental, and Medicaid multistate databases was performed. Patients prescribed IR hydrocodone during the 6-month baseline (July–December 2011), and with continuous enrollment during baseline and the 12-month follow-up (2012) were selected. HRU and per-patient-per-month (PPPM) costs (2014 US dollars) were assessed at follow-up. Descriptive analyses and multivariate regressions were conducted to compare HRU and costs at follow-up by days’ supply (<60 vs ≥60 days) and average doses per month (≤60 vs >60 doses/month) of IR hydrocodone at baseline.

Results:

In total, 1,698,845 commercial, 264,038 Medicare, and 151,063 Medicaid IR hydrocodone patients were identified. During follow-up, commercial patients with prior ≥60 days’ supply were more likely to have an inpatient admission (13.2% vs 7.5%), outpatient hospital visit (69.1% vs 57.0%), office visit (97.6% vs 91.0%), emergency room (ER) visit (28.1% vs 21.4%), and had higher PPPM total costs ($1494 vs $842) than the <60 days’ supply sub-group (all p < 0.05). Among commercial patients the adjusted odds ratio for prior ≥60 days’ supply of IR hydrocodone vs prior <60 days’ supply was 1.62 (inpatient), 1.33 (outpatient), 2.58 (office visit) and 1.48 (ER) (all p-values <0.05). Adjusted all-cause total costs were higher ($1245 vs $851, p <0.05) among commercial patients with longer days’ supply than those with shorter days’ supply. Trends were similar with ≤60 vs >60 doses per month sub-groups and across all plan types.

Conclusion:

Increased days’ supply and higher doses/month of IR hydrocodone in the prior 6 months may help to predict levels of HRU and costs in the following year, providing an opportunity to identify patients in order to implement interventions to improve their quality of care.

Keywords::

• Healthcare resource utilization
• Costs
• Hydrocodone
• Retrospective database

Transparency

Declaration of funding

This manuscript was funded by Purdue Pharma L.P.

Declaration of financial/other relationships

AK, AC, and CP are employees for Evidera, a consulting firm that received funding from Purdue Pharma L.P. for this research. PH is an employee for Purdue Pharma L.P., and JAB and RBJ were employees for Purdue Pharma at the time of the study. HW is a consultant on this project. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Lucy Pan of Evidera is acknowledged for her help with the discussion section. Shuo Yang and Samuel Huse of Evidera are acknowledged for their assistance with the analysis, and Taylor Whitworth of Evidera is acknowledged for her assistance in manuscript preparation.