Pubdate: Fri, 11 Aug 2017
Source: Boston Globe (MA)
Copyright: 2017 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52
Author: Casey Ross

THE COST OF TREATING OPIOID OVERDOSE VICTIMS IS RISING FAST

The cost of treating opioid overdose victims in hospital intensive
care units jumped 58 percent in a seven-year span, according to a new
study that concludes increasingly sick patients are placing a greater
strain on an overmatched health care system.

Between 2009 and 2015, the average cost of care per opioid admission
increased from $58,500 to $92,400 in the 162 academic hospitals
included in the study, which was led by Beth Israel Deaconess Medical
Center in Boston. That rapid escalation far outpaced the overall
medical inflation rate in the United States, which was about 19
percent during the period covered by the study.

Researchers said the cost increase highlights a troubling trend: that
overdose patients are arriving in worse shape, requiring longer stays
and a higher level of treatment.

More of them are also dying: Annual deaths in ICUs nearly doubled
during the study period.

"US critical care is awfully good and has a lot of resources, and
we're still not able to save a lot of these lives," said the lead
researcher, Dr. Jennifer P. Stevens, associate medical director of the
ICU at Beth Israel.

"That's really, really concerning," she said.

President Trump said on Thursday that he planned to declare a state of
emergency around the opioid crisis.

The study shows that deaths rose steadily for several years and then
began spiking in 2012. "I was particularly struck that the mortality
was increasing at such an alarming rate," Stevens said. "Our data goes
through September of 2015, and I'm sure the story has continued in an
even more complex way since then."

Stevens said many overdose patients need a longer duration of
mechanical ventilation and sedation, and many are suffering from more
severe consequences from drug use, such as liver and kidney failure.

The study does not address why patients are getting to the hospital in
worse shape. A number of factors may be at play: The opioids
circulating in many communities, such as fentanyl and carfentanil, are
more powerful. First responders may also be getting better at reviving
people in dire condition. And as the scope of the epidemic has
widened, hospitals may be seeing more patients with underlying health
issues that make them harder to treat and ultimately save.

Overall, the researchers found, the number of ICU admissions increased
34 percent over the seven-year period. Their study analyzed about 23
million admissions of adult patients across 44 states. Of the more
than 4 million patients who required intensive care, about 21,700
patients were admitted due to opioid overdoses.

The study only examined admissions within a consortium of academic
medical centers, most of which are located in urban areas. The data do
not reflect the scope or severity of the crisis in rural areas, or in
the community hospitals that generally have fewer resources to treat
overdose victims.

Stevens said another limiting factor was the study's reliance on
billing data. "I imagine that would not only underestimate the
incidence, but also the severity of the cases," she said, because the
billing data may not always reflect the reason for a patient's admission.

Stevens, who is also an associate professor at Harvard Medical School,
said she was motivated to examine the costs of opioid overdoses
because of her experience in the ICU, where she has witnessed the
worst impacts of the crisis.

Overdoses not only affect the patient, but entire communities that see
too many neighbors and colleagues die young.

"This is an epidemic that creeps into all of our lives in all sorts of
different ways," she said. "In the ICU, it's particularly dramatic -
the true tragedies that come from opioid use disorder."
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MAP posted-by: Matt