A study that tallied costs associated with chronic pain patients highlights a lack of effective care management in the healthcare system and inadequate monitoring by physicians when it comes to identifying and treating patients who exhibit signs of abuse.
Published in the American Journal of Managed Care, the authors of “Opioid Analgesic-Treated Chronic Pain Patients at Risk for Problematic Use,” compared the amount of healthcare services used and resulting costs for 3,891 patients with chronic pain and an opioid prescription.1 Patients were divided into three groups: patients with potentially problematic opioid use (PPOU) who had displayed evidence of “doctor shopping” to obtain opioid prescription refills or rapid dose escalation, patients who had at least one opioid prescription filled and a control group who fit none of the criteria. Groups were compared for a one-year period between 2009 and 2011.
The data showed those in the PPOU group had significantly higher pharmacy costs than the control group ($6,573 vs. $6,160), higher office visit costs ($5,705 vs. $4,479), higher emergency department (ED) costs ($835 vs. $388), higher inpatient costs ($15,646 vs. $7,445) and higher total healthcare costs ($39,048 vs. $26,171).
The authors note their findings “demonstrate a need for closer monitoring of PPOU patients … and interventions tailored to mitigate the effect of problematic use on patients and payers.” The authors suggest that “broadening the criteria beyond diagnosis codes to include indicators of potentially problematic use may have value to health plans and providers interested in improving outcomes and containing costs” and that such tools as addiction screening questionnaires and lab tests may help to improve “prescriber awareness” when it comes to patients at risk for opioid abuse.
“Nothing here is surprising to me,” says David Wanalista, DO, a veteran rheumatologist at Cumberland Medical Associates in Vineland, N.J. “Physicians realize this is a big issue, as far as the abuse. More doctors are referring out chronic pain patients. It’s a legal issue. It’s phone call after phone call. It’s frequently a problem when I am on vacation, in that covering physicians are hesitant to refill narcotics [for] patients they’re not completely familiar with.”
Although he questions some of the study design, Dr. Wanalista says cost-related research is something rheumatologists need more of. “We all know the healthcare system is strained right now, but we don’t know exactly where the strain is coming from. Most of us think it’s coming from the insurers, healthcare facilities and all the procedures we order,” he says. “I think the average doctor doesn’t realize the total cost involved with these particular types of patients … and most rheumatologists aren’t looking out for the ‘doctor-shopping’ patient.”
Dr. Wanalista says he was surprised to see the data on increased costs to EDs in the potentially problematic group. “That can be a significant toll,” he adds. “I say to myself, ‘Am I putting them in the ED? Are they overdosing because of me? Or are they going to the ED because I am not giving them the drug?’” (posted 5/16/14)
Richard Quinn is a freelance writer in New Jersey.
