The surging death toll from opioids has focused considerable attention on both heroin abuse and the role played by prescription drugs and those that use and prescribe them.

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

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

Fair Health, which manages a massive data base of medical stats and crunches them in the service of better and more transparent health services, examined opioid related data from 2007 through 2015. In an earlier report, it said it found an increase of more than 3,000 percent in claim lines referencing opioid dependence.

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

- The value of charges for opioid-related diagnoses rose more than 1,000 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 1,375 percent during that time, from $32 million to $446 million.
- In 2015, private payors’ average costs for a patient diagnosed with opioid abuse or dependence were more than 550 percent higher.
- That percent computed to almost $16,000 more per patient than the per-patient average cost based on all patients’ claims.
- Opioid abuse diagnoses involve significant emergency department charges, while opioid dependence charges are largely represented by laboratory tests and office outpatient visits.
- States’ average charges for services associated with opioid abuse and dependence diagnoses vary widely.

“In 2015 alone, services billed with an opioid dependence diagnosis (generally a more severe diagnosis than opioid abuse) amounted to $1,288 in charges per patient, and services billed with an opioid abuse diagnosis amounted to $1,088 per patient,” the report said. “The increase in charges for opioid abuse and dependence diagnoses is probably due to a combination of more people becoming addicted to opioids each year and more people seeking medical help each year for their opioid abuse or dependence.”

To view the cost of abuse and dependence on opioids in another way, consider the per-patient charges of the average health plan member to that of someone with an addiction: $11,404 vs. $63,356 in 2015.

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

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

“The opioid crisis is having a profound economic impact on the healthcare system. Both billed charges and allowed amounts for services associated with opioid abuse and opioid dependence have increased dramatically in recent years,” Fair Health said. “By reporting on the particular components of those costs, Fair Health hopes to inform and assist insurers as they design benefits, providers as they adjust to increasing demand for services and procedures, and legislators and policy makers as they try to make decisions in the best interests of public health.”

Instant Insights /

Study: Insurer spending on opioids rose 1,375 percent over four years

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