Caroline J. Enloe

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

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.

The Economic Burden of Diagnosed Opioid Abuse Among Commercially Insured Individuals

Abstract The abuse of prescription opioids imposes a substantial public health and economic burden. Recent research using administrative claims data has substantiated the prevalence and cost of opioid abuse among commercially insured individuals. Although administrative claims data are readily available and have been used to effectively answer research questions about the burden of illness for many different conditions, an important issue is the reliability, replicability, and generalizability of estimates derived from different databases. Therefore, this study sought to assess whether the findings of a recently published study of opioid abuse in a commercial claims database (original analysis) could be replicated in a different commercial claims database. The original analysis, which analyzed the prevalence and excess health care costs of diagnosed opioid abuse in the OptumHealth Reporting and Insights Database, was replicated by applying the same approach to the Truven MarketScan Commercial Claims and Encounters Database (replication analysis). In the replication analysis, the prevalence of diagnosed opioid abuse increased steadily from 15.8 diagnosed opioid abusers per 10 000 in 2009, to 26.6 diagnosed opioid abusers per 10 000 in 2012. Although the prevalence of diagnosed opioid abuse was higher than reported in the original analysis, the trend of increasing prevalence over time was consistent across analyses. Additionally, diagnosed abusers had excess annual per patient health care costs of

Basal Insulin Persistence, Associated Factors, and Outcomes After Treatment Initiation Among People With Type 2 Diabetes Mellitus In Japan

11 376 in the replication analysis, which was consistent with the excess annual per patient health care costs of diagnosed abuse of

Functional limitations and health care resource utilization for individuals with cognitive impairment without dementia: Findings from a United States population-based survey

10 627 reported in the original analysis. The replication analysis also found an upward trend in the prevalence of diagnosed opioid abuse over time and substantial excess annual per patient health care costs of diagnosed opioid abuse among commercially insured individuals, suggesting that these findings are generalizable to other commercially insured populations.

Functional limitations and healthcare resource utilization for individuals with cognitive impairment without dementia: Findings from a u.s. population-based survey

Continuers Interrupters P-value Discontinuers P-value (n=299) (n=349) (n=179) Demographics Age on index date, mean (SD) 50.8 (9.5) 49.5 (9.9) 0.086 48.7 (10.4) 0.019* Gender (male), % 69.6 70.8 0.737 73.2 0.399 Mode of delivery of index basal insulin, % Pen 92.0 95.1 0.100 95.5 0.132 Cartridge 8.0 4.9 0.100 4.5 0.132 Index basal insulin, % Insulin glargine 76.9 75.4 0.642 76.5 0.923 Insulin detemir 14.0 18.1 0.168 14.5 0.885 NPH 7.7 5.7 0.317 8.9 0.630 Degludec 1.3 0.9 0.709 0.0 0.302 Charlson comorbidity index, mean (SD) 2.8 (2.1) 3.2 (2.6) 0.151 2.9 (2.4) 0.950 Medical resource use, by setting (% with ≥1 visit) Inpatient 20.4 30.4 0.004* 36.3 <0.001* Outpatient 98.3 97.7 0.575 95.0 0.035* Number of primary care visits, mean (SD) 4.7 (2.4) 3.8 (2.4) <0.001* 3.3 (2.5) <0.001* Non-insulin antihyperglycemic prescription drug use Number of unique classes used, mean (SD) 2.5 (1.4) 2.1 (1.5) <0.001* 1.3 (1.5) <0.001* At least one prescription fill, % 87.0 79.7 0.014* 52.0 <0.001* Any oral antihyperglycemic drug 87.0 79.7 0.014* 52.0 <0.001* Any injectable 6.7 2.6 0.012* 2.8 0.064

The Economic Burden of Opioid Abuse: Updated Findings

Little is known about functional limitations and health care resource utilization of people with cognitive impairment with no dementia (CIND).

Characteristics of High-Cost Patients Diagnosed with Opioid Abuse

Age, mean 72.3 61.8* 72.2 73.2 Gender, % male 33.3% 41.4%* 33.5% 31.3% Years of education, mean 11.6 13.8* 11.6 11.8 Race, % Caucasian 82.7% 92.0%* 83.1% 83.6% Comorbidity profile, % Arthritis or rheumatism 67.2% 48.0%* 67.1% 65.4% Cancer 16.6% 10.6%* 16.7% 17.9% Chronic lung disease 9.4% 6.1%* 9.4% 9.7% Diabetes 21.1% 12.6%* 21.1% 15.5%* Emotional, nervous, or psychiatric problems 18.9% 12.1%* 18.9% 10.3%*