Public, private, and out-of-pocket spending comparisons between respondents with and without opioids and the impact of the Comprehensive Addiction Recovery Act, 2008-2020: A serial cross-sectional study.

BACKGROUND

Healthcare costs among opioid users in the United States (US) have increased adding to their economic burden. Moreover, the Comprehensive Addiction Recovery Act (CARA) may have impacted these trends. We sought to compare trends of Total, Public, Private, Out-of-pocket, and Other types of healthcare spending and the impact of CARA for respondents with and without an opioid prescription in the US.

METHODS

A serial cross-sectional design was used to evaluate trends in healthcare spending (Total, Public, Private, Out-of-pocket, and Other) between respondents with (Opioid) and without an opioid (Non-opioid) prescription in the US using the Medical Expenditure Panel Survey data between 2008 and 2020. Linear regression models were constructed to compare healthcare spending trends between the Opioid and Non-opioid groups. An interrupted time series analysis (ITSA) was performed to evaluate healthcare spending trends before and after CARA implementation between the groups.

RESULTS

The total weighted adult sample (N = 221,565,008) included 10 % (N = 22,143,556 in the Opioid group and 90 % (N = 199,421,453) in the Non-opioid group. Opioid respondents had significantly higher average Total (+$2491), Public (+$785), Private (+$1012), Out-of-pocket (+$315), and Other types (+$379) of healthcare costs compared to Non-opioid respondents. Between 2008 and 2020, Opioid respondents had greater increases in average annual Total (+358), Public (+$299), and Private (+$69) spending compared to Non-opioid respondents. In the ITSA analysis, immediately after CARA implementation, Opioid respondents had higher Total (+$1930) and Private (+1234) spending compared to Non-opioid respondents. No other meaningful changes in healthcare spending were reported due to CARA implementation.

CONCLUSIONS

Healthcare expenditures increased for both the Opioid and Non-opioid groups between 2008 and 2020; however, Opioid respondents were associated with higher rates of increased Total, Public, and Private healthcare spending. Immediately after CARA implementation, Opioid respondents had higher Total and Private healthcare spending but no other meaningful changes compared to Non-opioid respondents.