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Hospitalizations for injection drug use-associated infections increase in US
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Hospitalizations for serious infections related to IV administration of opioids in the United States substantially increased from 2002 to 2012, causing a considerable financial burden on the health care system, according to recent findings.
“The growing problem of opioid abuse in the United States has been well-documented, but our study is the first of its kind to quantify serious infections related to opioid abuse and their impact on the U.S. hospital system and on health care costs,” Shoshana J. Herzig, MD, MPH, director of hospital medicine research at Beth Israel Deaconess Medical Center and assistant professor of medicine at Harvard Medical School, said in a press release. “The downstream consequences of opioid abuse and dependence, including serious infection, are severe for individual patients and their loved ones, caregivers, hospital systems and the federal government. A commitment to decreasing access to opioids, early treatment, and preventive strategies will be vital to decrease the burden of disease and cost to the health care system and society.”
Shoshana Herzig
Matthew Ronan
Herzig and Matthew V. Ronan, MD, hospitalist at the VA Boston Healthcare System’s Roxbury Medical Center, conducted a retrospective cohort study using data from the Nationwide Inpatient Sample, developed by the Agency for Healthcare Research and Quality, to compare the national rates of hospitalizations for opioid use and related infections in 2002 and 2012. Sensitivity analyses restricting estimates to young patients without other risk factors were performed to ensure the increase in infections was related to opioid use.
While the number of hospitalizations in the U.S. in 2002 was nearly equivalent to those in 2012 (36.52 million vs. 36.48 million), the number of hospitalizations for opioid abuse/dependence with associated infections significantly increased 91% from 3,421 to 6,535, according to the researchers. Specifically, there was a 1.5-fold increase in endocarditis, a 2.2-fold increase in osteomyelitis, a 2.7-fold increase in septic arthritis and a 2.6-fold increase in epidural abscess. Herzig and Ronan observed a smaller rise in these infections among patients not diagnosed with opioid abuse/dependence, suggesting the infections occurred at an increased rate among patients with the condition, they wrote. Sensitivity analyses yielded similar results.
The increase in infections corresponded with an increase in inpatient charges for opioid abuse/dependence with associated infection, which more than tripled from 2002 to 2012 ($190.68 million vs. $700.66 million) and remained significant after adjusting for inflation (P < .001). In 2012, the estimated cost per hospitalization was $107,217.
The financial burden largely fell on government-funded agencies, the researchers wrote. Medicaid was the most common primary payer in both years for patients hospitalized for opioid abuse/dependence with associated infection. Only 14% of these patients were covered by private insurance, whereas 23% were uninsured.
“The high rate of uninsured status … could have implications for the care of these individuals,” the researchers wrote. “These high costs in the face of a high rate of uninsured status create perverse incentives wherein hospitals and care organizations may seek to transfer these patients to other health care systems or hospitals. The potential lack of ‘ownership’ of the patient’s care may exacerbate the already troubling issues related to access to care and ability to follow through on follow-up care demonstrated by others.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.
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