Estimating the health care burden of prescription opioid abuse in five European countries

Abstract

Background

Opioid abuse, including abuse of prescription opioids (“RxOs”) and illicit substances like heroin, is a serious public health issue in Europe. Currently, there is limited data on the magnitude of RxO abuse in Europe, despite increasing public and scientific interest in the issue. The purpose of this study was to use the best-available data to derive comparable estimates of the health care burden of RxO abuse in France, Germany, Italy, Spain, and the United Kingdom (EU5).

Methods

Published data on the prevalence of problem opioid use and the share of opioid abuse patients reporting misuse of non-heroin opioids were used to estimate the prevalence of RxO abuse in the EU5 countries. The costs of RxO abuse were calculated by applying published estimates of the incremental health care costs of opioid abuse to country-specific estimates of the costs of chronic pain conditions. These estimates were input into an economic model that quantified the health care burden of RxO abuse in each of the EU5 countries. Sensitivity analyses examined key assumptions.

Results

Based on best-available current data, prevalence estimates of RxO abuse ranged from 0.7 to 13.7 per 10,000 individuals across the EU5 countries. Estimates of the incremental health care costs of RxO abuse ranged from €900 to €2,551 per patient per year. The annual health care cost burden of RxO abuse ranged from €6,264 to €279,927 per 100,000 individuals across the EU5 countries.

Conclusion

This study suggests that RxO abuse imposes a cost burden on health systems in the five largest European countries. The extent of RxO abuse in Europe should be monitored given the potential for change over time. Continued efforts should be made to collect reliable data on the prevalence and costs of RxO abuse in Europe to facilitate an accurate characterization of the extent of this potentially growing problem.

Keywords:

• prescription opioids
• abuse
• prevalence
• health care costs

Supplementary materials

Model calculations

The following equations describe the precise calculations underlying the economic model.

Step 1: Prevalence of prescription opioid (RxO) abuse.

• A_i = Prevalence of problem opioid use in country i (%)

• A_i^* = Prevalence of problem opioid use (excluding RxO abuse) in country i (%)

• B_i = Percentage of opioid users entering treatment in country i who misuse non-heroin opioids (%)

• C_i = A_i × B_i = Prevalence of RxO abuse in country i (%)

Note: In countries for which the prevalence of problem opioid use excluding RxO abuse was reported (ie, France and Spain), A_i was scaled up using the estimated percentage of opioid users entering treatment who misuse non-heroin opioids: A_i = A_i^*/(1 – B_i).

Step 2: Health care costs of chronic pain conditions.

• D_i = Health care costs of chronic pain conditions in country i (euros)

• E_i = Harmonized Indices of Consumer Prices (HICP) inflation factor

• F_i = D_i × E_i = Adjusted health care costs of chronic pain conditions in country i (2013 euros)

Note: In addition to the adjustment of all cost estimates to account for inflation, estimated costs in the UK were converted from pound sterling (£) to euros (€).¹

Step 3: Incremental health care costs of RxO abuse.

• G = Health care costs incurred by RxO abusers in the US (2012 US dollars)

• H = Health care costs incurred by non-abusers in the US (2012 US dollars)

• J_i = F_i × [(G – H)/H] = Incremental health care costs of RxO abuse in country i (2013 euros).

Step 4: Annual health care burden of RxO abuse.

• K_i = Population aged 15–64 years in country i

• L_i = C_i × K_i × J_i = Annual health care burden of RxO abuse in country i (2013 euros)

Step 5: Population adjustments.

• M_i = (L_i/K_i) × 100,000 = Annual health care burden of RxO abuse per 100,000 individuals in country i (2013 euros)

Table S1 Published studies on the costs of chronic pain conditions in the EU5 countries

Table S2 Overall annual health care burden of RxO abuse: sensitivity analyses

Acknowledgments

The authors wish to acknowledge the contributions of Rami Ben-Joseph, PhD, to the overall inception and design of this project. Dr Ben-Joseph is an employee of Purdue Pharma LP.

Disclosure

This study was funded by Mundipharma International Limited. MH and WCND are employees of Mundipharma International Limited; AS, NYK, CJE, and HGB are employees of Analysis Group, Inc., a consulting company that received funding for this research from Mundipharma International Limited. The authors report no other conflicts of interest in this work.