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

Figures & data

Table 1 Prevalence of RxO abuse

Estimate	France	Germany	Italy	Spain	United Kingdom
Ai
Prevalence of problem opioid use (% of population aged 15–64 years)	0.61	0.32	0.48	0.12	0.82
Bi
Percentage who misuse non-heroin opioids (% of opioid users entering treatment)	22.6	34.7	1.6	5.7	13.1
Ci = Ai× Bi
Prevalence of RxO abuse (per 10,000 individuals aged 15–64 years)	13.7	11.0	0.8	0.7	10.7

Abbreviation: RxO, prescription opioid.

Figure 1 Per patient annual incremental health care costs of RxO abuse.

Note: All costs are reported in 2013 euros.
Abbreviation: RxO, prescription opioid.

Figure 2 Population-adjusted annual health care burden of RxO abuse.

Note: All costs are reported in 2013 euros.
Abbreviation: RxO, prescription opioid.

Table 2 Overall annual health care burden of RxO abuse: core results and summary of sensitivity analyses

Estimate	France	Germany	Italy	Spain	United Kingdom
Ci
Prevalence of RxO abuse (% of population aged 15–64 years)	0.137	0.110	0.008	0.007	0.107
Ki
Population aged 15–64 years in 2010 (thousands)	41,001	54,610	39,735	31,389	40,871
Ji
Per patient annual incremental health care costs of RxO abuse	€1,737	€2,551	€1,437	€900	€1,501
Li = Ci × Ki × Ji
Annual health care burden of RxO abuse	€97.9 million	€152.9 million	€4.3 million	€2.0 million	€65.7 million
Mi = (Li/Ki) × 100,00 0
Annual health care burden of RxO abuse, per 100,000 individuals aged 15–64 years	€238,691	€279,927	€10,901	€6,264	€160,835
Sensitivity A Higher estimate of the percentage of opioid users entering treatment who misuse non-heroin opioids
Li* = Ci* × Ki × Ji
Annual health care burden of RxO abuse	€278.1 million	€306.7 million	€8.7 million	€4.2 million	€131.9 million
Sensitivity B Lower ratio of incremental health care costs of RxO abusers to those of matched control patients
Li# = Ci × Ki × Ji#
Annual health care burden of RxO abuse	€29.8 million	€46.6 million	€1.3 million	€0.6 million	€20.0 million
Sensitivity C Lower estimates of the annual health care costs of chronic pain conditions
Li‡ = Ci × Ki × Ji‡
Annual health care burden of RxO abuse	€97.9 million	€46.3 million	€2.4 million	€1.3 million	€65.7 million

Notes: All costs are reported in 2013 euros. Calculations for sensitivity A, sensitivity B, and sensitivity C are denoted with

*, #, and ‡, respectively.

Abbreviation: RxO, prescription opioid.

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

Country	Study	Title	Annual cost estimate
France	Depont et al^Citation14	Medical and non-medical direct costs of chronic low back pain in patients consulting primary care physicians in France	€1,588
Germany	Langley^Citation15	The societal burden of pain in Germany: health-related quality-of-life, health status, and direct medical costs	€2,333
	Becker et al^Citation22	Low back pain in primary care: costs of care and prediction of future health care utilization	€2,007
	Wenig et al^Citation19	Costs of back pain in Germany	€706
	Becker et al^Citation23	Cost evaluation by a patient questionnaire: pilot study of a weekly cost diary	€2,030
Italy	Colombo et al^Citation16	Quality of life and treatment costs in patients with non-cancer chronic pain	€1,314
	Leardini et al^Citation20	Direct and indirect costs of osteoarthritis of the knee	€715
Spain	Loza et al^Citation17	Economic burden of knee and hip osteoarthritis in Spain	€822
	Núñez et al^Citation21	Health-related costs in patients with osteoarthritis on waiting list for total knee replacement	€551
UK	Hong et al^Citation18	Costs associated with treatment of chronic low back pain: an analysis of the UK General Practice Research Database	€1,372

Note: All costs are reported in 2013 euros.

Abbreviation: EU5, France, Germany, Italy, Spain, and the United Kingdom.

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

Estimate	France	Germany	Italy	Spain	United Kingdom
Sensitivity A Higher estimate of the percentage of opioid users entering treatment who misuse non-heroin opioids
Ci*
Prevalence of RxO abuse (% of population aged 15–64 years)	0.391	0.220	0.015	0.015	0.215
Ki
Population aged 15–64 years in 2010 (thousands)	41,001	54,610	39,735	31,389	40,871
Ji
Per patient annual incremental health care costs of RxO abuse	€1,737	€2,551	€1,437	€900	€1,501
Li* = Ci* × Ki × Ji
Annual health care burden of RxO abuse	€278.1 million	€306.7 million	€8.7 million	€4.2 million	€131.9 million
Sensitivity B Lower ratio of incremental health care costs of RxO abusers to those of matched control patients
Ci
Prevalence of RxO abuse (% of population aged 15–64 years)	0.137	0.110	0.008	0.007	0.107
Ki
Population aged 15–64 years in 2010 (thousands)	41,001	54,610	39,735	31,389	40,871
Ji#
Per patient annual incremental health care costs of RxO abuse	€529	€777	€438	€274	€457
Li# = Ci × Ki × Ji#
Annual health care burden of RxO abuse	€29.8 million	€46.6 million	€1.3 million	€0.6 million	€20.0 million
Sensitivity C Lower estimates of the annual health care costs of chronic pain conditions
Ci
Prevalence of RxO abuse (% of population aged 15–64 years)	0.137	0.110	0.008	0.007	0.107
Ki
Population aged 15–64 years in 2010 (thousands)	41,001	54,610	39,735	31,389	40,871
Ji‡
Per patient annual incremental health care costs of RxO abuse	€1,737	€772	€783	€603	€1,501
Li‡ = Ci × Ki × Ji‡
Annual health care burden of RxO abuse	€97.9 million	€46.3 million	€2.4 million	€1.3 million	€65.7 million

Notes: All costs are reported in 2013 euros. Calculations for sensitivity A, sensitivity B, and sensitivity C are denoted with

*, #, and ‡, respectively.

Abbreviation: RxO, prescription opioid.

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