(P-312) Disease Prevalence, Comorbidities, and Medication Utilization Among Patients with Opioid Use Disorder in the US

Background: Estimates of comorbidities and medication utilization among patients with opioid use disorder (OUD) vary by database.

Objectives: Describe disease prevalence, demographics, comorbidities, and medication utilization among patients diagnosed with OUD in the US.

Methods: The IBM® MarketScan® Commercial (Commercial) and Multi-State Medicaid Databases (1/1/2009 – 12/31/19) were used for this cross-sectional analysis. OUD cases were defined by ≥1 diagnostic claim (ICD-9-CM/ICD-10-CM) for opioid-related conditions during the study period. Comorbidities were assessed by ≥1 ICD-9-CM/ICD-10-CM diagnosis code, grouped by Clinical Classifications Software level 2 categories. For the comorbidity analysis, OUD cases were matched with controls on key demographic characteristics. Comparisons were performed using prevalence rate ratios (PRRs). Medications were assessed for cases using ≥1 National Drug Code in the outpatient setting grouped by RED BOOK® classification.

Results: Key differences exist for Medicaid vs Commercial patients, with higher OUD prevalence (2.3% vs 0.5%) and higher proportion of females (56.7% vs 44.9%), respectively. For comorbidities, screening and history of mental health and substance abuse codes was higher in Medicaid vs Commercial (57.4% vs 35.7%). The most frequent comorbidities common in both databases were mood disorders (Medicaid vs Commerical; 65.7% vs 55.8%), spondylosis/intervertebral disc disorders/other back problems (62.4% vs 62.9%), anxiety disorders (63.4% vs 53.8%), other connective tissue disease (61.4% vs 59.0%), and respiratory infections (61.5% vs 58.5%). Poisoning and coma/stupor/brain damage were among the top 5 case-control PRRs for Medicaid but not for Commercial. The top comorbidity PRRs across databases included suicide and intentional self-inflicted injury (Medicaid vs Commercial; 4.9 vs 14.4), personality disorders (3.8 vs 12.0), aspiration pneumonitis; food/vomitus (3.7 vs 8.6), and alcohol-related disorders (3.5 vs 10.1). The most prescribed medications for cases in both databases were analgesics/antipyretics - opiate agonists (Medicaid vs Commercial; 70.7% vs 69.3%); analgesics/antipyretics - nonsteroidal/anti-inflammatory (70.4% vs 54.8%), and psychotherapeutics - antidepressants (65.7% vs 64.8%).

Conclusions: While similarities were observed in the most frequent comorbidities and medications utilized between Medicaid and Commercial OUD patients, there are key differences in disease prevalence and comorbidities more generally. This should be taken into consideration when designing studies and interpreting findings.