The economic burden of the opioid crisis on Texas health care facilities has been greatly underestimated

A new study led by Texas A&M Health and its Texas A&M Opioid Task Force that used an unprecedented method of analyzing the data hospitals use to code opioid diagnoses has found that the financial cost of the opioid crisis in Texas is much higher than previously thought.

As part of the Texas A&M Triads for Transformation program, the study was co-directed by Lixian Zhong, PhD, associate professor in the School of Pharmacy, Marcia G. Ory, PhD, MPH, Regents and Distinguished Professor of Environmental and Occupational Health in the School of Public Health, and Meri Davlasheridze, PhD, associate professor in the Department of Marine and Coastal Environmental Science at Texas A&M University at Galveston, along with other colleagues.

“Our goal was to quantify the economic burden associated with opioid misuse in Texas by measuring the amount of health care resources devoted to this,” Zhong said. “We found that opioid use disorder is huge, and yet still greatly underreported, across the state.”

For this retrospective, cross-sectional study, the researchers first analyzed inpatient, outpatient and emergency department administrative data across Texas using ICD-10-CM codes related to opioid abuse, adverse effects, dependence and poisoning-identified opioid-related clinical encounters.

“Researchers typically use the diagnosis codes used in administrative claims or electronic health records to identify the patients needed for a study,” Zhong said. “But health services researchers use different criteria in their coding, and this results in different outcomes in assessing disease incidence, prevalence, health care utilization and cost.”

The team then analyzed the data using both high-specificity definition criteria (which are more precise but may lead to more false negative cases resulting in underestimation) and high-sensitivity definition criteria (which captures more cases of the condition being studied, but with more false positive cases leading to overestimation).

Most previous studies of opioid-related health care use just one set of case identification criteria—such as only principal diagnosis codes to identify related clinical encounters—or use all diagnosis codes, which include principal and all secondary diagnoses, Zhong said. To create a more apples-to-apples comparison, the researchers used both high-sensitivity and high-specificity definition criteria to identify opioid-related clinical encounters.

Ory said this study also was the first to use a comprehensive list of opioid-related ICD-10 codes following the U.S. Agency for Healthcare Research and Quality methods to study Texas opioid-related clinical encounters by incorporating four major categories related to opioid use: opioid abuse, adverse effects, dependence and poisoning.

“We believe other states could use these definitions and methodologies to give us a better national understanding of public health impacts,” Ory said.

The team applied descriptive statistics to evaluate the resource utilization and economic burden in different clinical settings and by different types of opioid misuse, and multivariable logistic regression models to identify the association with patients’ characteristics.

“We found that the demographic profile of those in opioid-related visits was similar to what previous studies found using national data,” Zhong said. “The typical patient was between 18 and 44 years old, male, white, non-Hispanic and more likely to be uninsured or covered by Medicaid.”

In this study, however, the high-sensitivity definition identified three to six times more opioid-related clinical encounters than the high-specificity definition (31,901 compared to 10,423 outpatient visits and 47,021 compared to 7,444 inpatient visits). In addition, the total health care charges related to opioid misuse in 2016 was estimated to be $0.27 billion using the high-specificity definition and $2.6 billion using the high-sensitivity definition.

Ory said that while Texas is one of the most populous states in the United States, with more than 30 million residents, it is not among the states with the most opioid-related problems.

“Still,” she said, “this study shows that the burden of opioid use disorders in terms of health care resource utilization and economic burden in Texas is staggering, and only growing due to the influx of illegally manufactured fentanyl. Thus, the Texas A&M Opioid Task Force is committed to engaging in additional research, education and practice to combat the escalating opioid crisis in Texas.”