Costs of substance use disorders from claims data for Medicare recipients from a population-based sample

This is a brief report published in February 2017 issue of the Journal of Substance Abuse Treatment by myself and colleagues from the Johns Hopkins Bloomberg School of Public Health. In this paper, we compared the total Medicare costs of eligible recipients based upon their history of substance use disorders (SUD). We found that, in general, those with a SUD history had higher Medicare costs than those without a SUD history. I’ll discuss this finding in a bit more detail below and link to the abstract.

The participants for this study came from the Baltimore cohort of the Epidemiologic Catchment Area Study. We compared those who had a history of SUD based on (A) self-report interview only, (B) Medicare claims data only, or (C) both with those who (D) did not have a history of SUD. We found that those who had a SUD history based on Medicare claims only or both (i.e., groups B and C) had higher Medicare costs than those without a history (i.e., group D). However, those who had a SUD history based on self-report alone (i.e., group A) had lower costs.

While these findings suggest that a history of SUD may be associated with higher Medicare costs (perhaps implicating the need for better and expanded access to substance treatment to reduce costs), much remains unclear. For instance, it is unclear to what degree the higher costs are directly or indirectly related to individual’s SUD (this was not within the scope of our study). The study also could not account for those who never make it to the age of Medicare eligibility due to their SUD (e.g., premature mortality). This could possibly explain why those with a history of SUD based on self-report alone had lower costs, although other explanations could account for this finding (e.g., perhaps these individuals’ SUD remitted earlier in life or received treatment, and as a result become more health conscious overall).

Nonetheless, these findings are noteworthy because many studies on the costs related to Medicare are based on Medicare data alone (not surprisingly). What was unique about our study was linking Medicare data to participants who were interviewed as part of a population-based epidemiologic study. This allowed us to examine cases of SUD in the population who may never come to the attention of health professionals. It highlights that source of SUD diagnosis can affect the associated Medicare costs.

Costs of substance use disorders from claims data for Medicare recipients from a population-based sample


Medicare spending is projected to increase over the next decade, including for substance use disorders (SUD). Our objective was to determine whether SUDs are associated with higher six-year Medicare costs (1999-2004) among participants in the Baltimore Epidemiologic Catchment Area (ECA) Study. Medicare claims data for the years 1999-2004 from the Centers for Medicare and Medicaid Services were linked to four waves of data from the Baltimore ECA cohort collected between 1981 and 2005 (n=566). A generalized linear model with a log link and gamma distribution was used to examine direct Medicare costs associated with SUD status. Medicare recipients with no history of SUD had mean six-year costs of $42,576. Those with a history of SUD based on both Baltimore ECA and Medicare data, or based on Medicare claims data alone, had significantly higher costs ($98,754 and $64,876, respectively). A history of SUD based solely on Baltimore ECA data alone had lower average costs ($25,491). Findings indicate that Medicare costs differ by source of SUD diagnosis when comparing treatment versus survey data. This may have future implications for projecting Medicare costs among SUD individuals as healthcare coverage expands under the Affordable Care Act.

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