OBJECTIVES: CDC issued naloxone co-prescribing recommendations for patients at risk for opioid overdose (OO). A large claims database was analyzed to assess the economic burden of high dose (>50 morphine milligram equivalents, MME) and low dose (<50MME) OO patients.

METHODS: This retrospective analysis used anonymized Commercial, Managed Medicare and Medicaid patient claims from the US Optum database. Patients with an OO were identified using medical claims and prescription for opioid in the prior or on index day (first OO date) between Jan 2016–Dec 2019. Patients >18 years at index, had continuous enrollment of 365 days pre- and 365 days post-index date were included. High (HDOOP) and low-dose (LDOOP) OO patients were identified and analyzed by insurance, state, comorbidities, costs overall as well as with and without naloxone use.

RESULTS: 6,833 HDOOP and 10,665 LDOOP were identified. Overall, 45.64% of HDOOP were 50-64 years, 63.71% female, 62.06% Caucasian, and 61.08% Medicare, and FL (10.07%) had highest rates. Overall, 42.72% of LDOOP were 50-64 years, 67.80% female, 58.23% Caucasian, and 50.59% had Medicare, and TX (12.30%) had highest rates. The average index event costs and Charlson Comorbidity Index score for HDOOP and LDOOP were $12,529.16 vs. $10,571.86 and 2.88 vs. 2.30, respectively. Index event costs with and without naloxone for HDOOP were $4,979.32 vs. $13,262.56 and for LDOOP $5,228.26 vs. $11,127.18, respectively. Based on a conservative estimate, using the cost difference with and without naloxone use, 100,000 HDOOP and 100,000 LDOOP results in ~$1.23 and ~$1.41 billion, respectively in annual savings to Medicare.

CONCLUSIONS: This study demonstrated higher LDOOP rates and both groups had a substantial economic burden on the US healthcare system. Though naloxone had lower costs at index event, naloxone remains under dispensed. Payers and policymakers may consider expanding naloxone co-prescribing for at-risk LOODP?