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 U.S., 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.
“U.S. 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.”