The surging death toll from opioids has focused considerableattention on both heroin abuse and the role played by prescription drugs and thosethat use and prescribe them.


But what’s the cost to the health care system of thisepidemic?


A New York City-based nonprofit called Fair Health hasresearched the topic and come up with some numbers.


Fair Health, which manages a massive data base of medical statsand crunches them in the service of better and more transparenthealth services, examined opioid related data from 2007 through2015. In an earlier report, it said it found an increase of morethan 3,000 percent in claim lines referencing opioid dependence.


In its latest report on the epidemic, it reviewed more than 21bits of claims data, focusing this time on the 2011-2015 period.Among its findings:

  • The value of charges for opioid-related diagnoses rose more than1,000 percent.

  • In total dollars, the increase went from $72 million in 2011 to$722 million in 2015.

  • The allowed amount that insurers forked out rose by 1,375percent during that time, from $32 million to $446 million.

  • In 2015, private payors’ average costs for a patient diagnosedwith opioid abuse or dependencewere more than 550 percent higher.

  • That percent computed to almost $16,000 more per patient thanthe per-patient average cost based on all patients’ claims.

  • Opioid abuse diagnoses involve significant emergency departmentcharges, while opioid dependence charges are largely represented bylaboratory tests and office outpatient visits.

  • States’ average charges for services associated with opioidabuse and dependence diagnoses vary widely.

“In 2015 alone, services billed with an opioid dependencediagnosis (generally a more severe diagnosis than opioid abuse)amounted to $1,288 in charges per patient, and services billed withan opioid abuse diagnosis amounted to $1,088 per patient,” thereport said. “The increase in charges for opioid abuse anddependence diagnoses is probably due to a combination of morepeople becoming addicted to opioids each year and more peopleseeking medical help each year for their opioid abuse ordependence.”


To view the cost of abuse and dependence on opioids in anotherway, consider the per-patient charges of the average health planmember to that of someone with an addiction: $11,404 vs. $63,356 in2015.


The study noted that opioid abuse charges are less than thoseincurred by those with a diagnosis of dependence; the average“service call” charge was $124 for the former and $170 for thelatter, suggesting that early intervention can save millions.


Fair Health concluded that, based upon its cost estimates, allinvested parties need to rapidly develop a cohesive strategy toreverse the opioid trend.


“The opioid crisis is having a profound economic impact on thehealthcare system. Both billed charges and allowed amounts forservices associated with opioid abuse and opioid dependence haveincreased dramatically in recent years,” Fair Health said. “Byreporting on the particular components of those costs, Fair Healthhopes to inform and assist insurers as they design benefits,providers as they adjust to increasing demand for services andprocedures, and legislators and policy makers as they try to makedecisions in the best interests of public health.”

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Dan Cook

Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.