• Noam Y Kirson, Amie Shei, J Bradford Rice, Caroline J Enloe, Katharine Bodnar, Howard G Birnbaum, Pamela Holly, and Rami Ben-Joseph.
• Analysis Group, Inc., Boston, Massachusetts.
• Pain Med. 2015 Jul 1; 16 (7): 1325-32.

ObjectivesEstimate the prevalence and healthcare costs of undiagnosed opioid abuse among commercially insured individuals.Study DesignRetrospective analysis of de-identified pharmacy and medical claims data and publicly-available survey data (no IRB approval required).MethodsThis study focused on commercially insured individuals. Rates of prescription pain-reliever abuse/dependence ("abuse") among individuals ages ≥12 were calculated using National Survey on Drug Use and Health (NSDUH) public-use data for 2006-2011 and assumed to capture both diagnosed and undiagnosed opioid abuse. Rates of undiagnosed opioid abuse were calculated as the difference between NSDUH rates and published rates of diagnosed opioid abuse. OptumHealth Reporting and Insights claims data were used to estimate the healthcare costs of undiagnosed abuse. Diagnosed abusers ages 12-64 were identified using ICD-9-CM diagnosis codes for opioid abuse/dependence. Pre-diagnosis costs were assumed to be a proxy for undiagnosed opioid abuse costs. The ratio of undiagnosed to diagnosed abuse costs was calculated as the ratio of annual per-patient healthcare costs between pre-diagnosis and post-diagnosis periods.ResultsWhile rates of diagnosed opioid abuse among commercially insured individuals increased from 0.07% in 2006 to 0.19% in 2011, rates of undiagnosed abuse decreased from 0.42% to 0.38% over the same time period. Annual per-patient healthcare costs of undiagnosed abusers were 69.2% of those of diagnosed abusers.ConclusionsPer-patient healthcare costs of undiagnosed abusers among the commercially insured are estimated to be lower than those of diagnosed abusers. However, the higher prevalence of undiagnosed opioid abuse implies that undiagnosed abuse represents a substantial burden to commercial payers.© 2015 American Academy of Pain Medicine.

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