Substance use disorders (SUDs) cost employer-sponsored health insurance plans $35.3 billion in the United States in 2018, a study in JAMA Network Open has found. Alcohol use disorder was found to be the most costly at $10.2 billion a year, followed by opioid use disorder at $7.3 billion a year.
Mengyao Li, Ph.D., of the Centers for Disease Control and Prevention and colleagues examined data from Merative MarketScan 2018 Commercial Claims and Encounters Databases, which report expenditures for inpatient services, outpatient services, and outpatient medications from approximately 350 health insurance payers. The researchers compared the medical costs of 210,225 people who had an SUD diagnosis with those of 1,049,539 people who did not have an SUD diagnosis.
The mean total annual medical expenditure was roughly $26,000 per person with an SUD diagnosis, compared with roughly $10,400 per person without an SUD diagnosis. Additional analysis revealed that the annual attributable mean cost of any SUD diagnosis (including multiple SUD diagnoses) was roughly $15,640. Having an SUD diagnosis was associated with costs of roughly $6,500 for inpatient services, $8,600 for outpatient services, and $1,500 for outpatient medications.
The researchers wrote that their findings likely underestimated the actual medical costs that employers and their health insurance payers face because only 1% of the study population had an SUD diagnosis, compared with 11% of workers who self-reported an SUD in previous research that was conducted by the Substance Abuse and Mental Health Services Administration.
“Medical expenditures for SUDs represent the minimum direct cost that employers and health insurers face because not all people with SUDs have a diagnosis, and costs related to absenteeism, presenteeism, job retention, and mortality are not addressed,” Li and colleagues wrote.
Yet the researchers also noted that the $35.3 billion in medical costs associated with SUD diagnoses are a small fraction of the $1.1 trillion paid by private insurance in 2018 for personal health care expenditures.
They added that employers can take action by developing workplace-supported prevention, treatment, and recovery programs.
“The cost of strategies to support employees and their health insurance dependents to prevent and treat SUDs can be considered in terms of potentially offsetting the existing high medical cost of SUDs,” they wrote.
For addition reading, see the Psychiatric Services article “Cost Offsets of Treatment for Serious Mental Illness and Substance Use Disorder.”
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