The economic burden of prescription opioid abuse is believed to be substantial, however it is not known whether total and per-event hospital (ED and inpatient) costs associated with opioid abuse or misuse differ by insurance status. We also wanted identify predictors of charges. We used the 2006, 2007, and 2008 files of the Healthcare Cost and Utilization Project's Nationwide Emergency Departments Sample (HCUP-NEDS) to identify events and charges assigned opioid abuse, dependence, or poisoning ICD-9-CM diagnosis codes (304.0X, 304.7X, 305.5X, 965.00, 965.02, 965.09). Using methods to account for the sampling design of the NEDS, we estimated national total and mean charges -- overall and by insurance status (Medicare, Medicaid, private insurance, or self-payment). Charges were adjusted using the 2010 Medical Consumer Price Hospital Services index. We used a log-linked gamma regression model to assess potential predictors of charges. The number of opioid abuse-related events was 515,896; 506,837; and 564,559 for 2006, 2007, and 2008, respectively. Approximately 55% visits in each year resulted in inpatient admissions. Total charges billed for opioid abuse-related events were US$9.8; 9.6; and 9.5 billion for 2006, 2007, and 2008, respectively. Medicaid patients had the highest charges in each years followed by Medicare patients. Approximately 93% of total charges were due to subsequent inpatient admission. Overall unadjusted mean charges were $20,651; $20,373; and $18,384 for 2006, 2007, and 2008, respectively. Compared to events paid for by private insurance, Medicaid-covered events had significantly higher mean charges, and self-paid events had significantly lower charges (p < 0.001 for each year). Inpatient admissions resulted in significantly higher mean charges compared to treat-and-release ED visits (p < 0.001 for each year). We found similar results after adjusting for clinical and demographic factors. Age, number of diagnoses, inpatient admission, presence of cardiac tissue disorders, respiratory infections or failure, gastrointestinal hemorrhage, and acute pancreatitis were significantly positively associated with total charges billed (p < 0.001 for all). This study helps in determining differences in hospital costs of opioid abusers by insurance status and in identifying potential predictors of such costs, resulting in better understanding the economic burden of opioid abuse on the healthcare system. / text

Class of 2011 Abstract / OBJECTIVES: The overall purpose of this study was to describe comorbidities, charges, and mortality associated with inpatient, adult traumatic brain injury (TBI) cases in the United States (US) for the year 2007. METHODS: This was a retrospective cohort analysis of discharge records located in the National Emergency Department Sample (NEDS) of the Healthcare Cost and Utilization Project (HCUP). Descriptive statistics are provided for comorbidities, charges, and mortality. Logistic regression was performed to find characteristics associated with mortality while multiple regression was used to assess charges. Independent variables included age, injury severity, procedures used, location of TBI, and primary payer. RESULTS: A total of 639,698 TBI cases were found which were associated with 267,061 hospital admissions, over $17 billion in hospital charges, and 20,620 deaths in the year 2007.Most common comorbidities were essential hypertension, sprains and strains of the back, tobacco use, fluid and electrolyte disorders, and alcohol-related disorders. Characteristics associated with increased mortality and charges included New Injury Severity Score (NISS) over 10, involvement of a firearm, falls, motor vehicle traffic, and intubation. CONCLUSION: The current study gives the most current picture of inpatient adult TBI cases throughout the US. Future research is warranted to ensure that optimal outcomes are being attained in this vulnerable patient population.