Study: Pain Patients Who Show Signs of Trouble Cost Health Plan an Extra $12,877 a Year

"Broadening the criteria beyond diagnostic codes to include indicators of potentially problematic use may have value to health plans and providers interested in improving outcomes and containing costs," researchers wrote.

A study of Aetna patients taking pain medication, compared to a control group, revealed that patients who display problematic behaviors have higher healthcare costs, even if they have not been diagnosed with addiction.

PLAINSBORO, N.J. – A study of patients being treated for chronic pain found that those who displayed warning signs – such as rapid dose escalation and doctor shopping – cost their health plan an extra $12,877 a year each on average, compared to a control group in the study. (Click here for full study)

The study looked at health claims data for 3,891 patients enrolled in Aetna, examining three groups: those taking pain medication who exhibited specific warning signs, those taking medication who did not show such signs, and a control group. The study examined whether those who display certain behaviors but have not been formally diagnosed with addiction still burden the system with added costs.

Of the patients in the study, 39 percent showed signs of problematic behavior, which included: doctor shopping (defined as receiving fills from five or more prescribers in a year), or rapid dose escalation (defined as either a 50 percent increase in opioid dose in the first three months, or a 100 percent increase in the follow-up period). Compared with the control group this group had:

• Higher pharmacy costs ($6,573 compared to $6,160)
• Higher office visit costs ($5,705 compared to $4,470)
• Higher emergency department costs ($835 compared to $388)
• Higher inpatient costs ($15,646 compared to $7,445)
• And higher total healthcare costs ($39,048 compared to $26,171).

The group displaying problematic behavior also had higher costs than those who had at least one pain prescription but did not show such behavior. Researchers, led by Joseph Tkacz, MS, and Jacqueline Pesa, PhD MPH, wrote that focusing only on pain patients with an addiction diagnosis overlooks others with potential problems. “Broadening the criteria beyond diagnostic codes to include indicators of potentially problematic use may have value to health plans and providers interested in improving outcomes and containing costs,” they wrote.

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