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Background Prescription drug abuse in the United States and elsewhere in the world is increasing at an alarming rate with non-medical opioid use, in particular, increasing to epidemic proportions over the past two decades. It is imperative to identify individuals most likely to develop opioid abuse or dependence to inform large-scale, targeted prevention efforts. Methods The present investigation utilized a large commercial insurance claims database to identify demographic, mental health, physical health, and healthcare service utilization variables that differentiate persons who receive an opioid abuse or dependence diagnosis within two years of filling an opioid prescription (OUDs) from those who do not receive such a diagnosis within the same time frame (non-OUDs). Results When compared to non-OUDs, OUDs were more likely to: (1) be male (59.9% vs. 44.2% for non-OUDs) and younger (M = 37.9 vs. 47.7); (2) have a prescription history of more opioids (1.7 vs. 1.2), and more days supply of opioids (M = 272.5, vs. M = 33.2; (3) have prescriptions filled at more pharmacies (M = 3.3 per year vs. M = 1.3); (4) have greater rates of psychiatric disorders; (5) utilize more medical and psychiatric services; and (6) be prescribed more concomitant medications. A predictive model incorporating these findings was 79.5% concordant with actual OUDs in the data set. Conclusions Understanding correlates of OUD development can help to predict risk and inform prevention efforts.

Robert L Page II,1 Vahram Ghushchyan,2 Jill Van Den Bos,3 Travis J Gray,3 Greta L Hoetzer,4 Durgesh Bhandary,4 Kavita V Nair1 1Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 2College of Business and Economics, American University of Armenia, Yerevan, Armenia; 3Milliman, Inc, Denver, CO, 4AstraZeneca, US Medical Affairs, Wilmington, DE, USA Background: No studies have addressed the cost of inpatient mortality during an acute coronary syndrome (ACS) admission. Objective: Compare ACS-related length of stay (LOS), total admission cost, and total admission cost by day of discharge/death for patients who died during an inpatient admission with a matched cohort discharged alive following an ACS-related inpatient stay. Methods: Medical and pharmacy claims (2009–2012) were used to identify admissions with a primary diagnosis of ACS from patients with at least 6 months of continuous enrollment prior to an ACS admission. Patients who died during their ACS admission (deceased cohort) were matched (one-to-one) to those who survived (survived cohort) on age, sex, year of admission, Chronic Condition Index score, and prior revascularization. Mean LOS, total admission cost, and total admission cost by the day of discharge/death for the deceased cohort were compared with the survived cohort. A generalized linear model with log transformation was used to estimate the differences in the total expected incremental cost of an ACS admission and by the day of discharge/death between cohorts. A negative binomial model was used to estimate differences in the LOS between the two cohorts. Costs were inflated to 2013 dollars. Results: A total of 1,320 ACS claims from patients who died (n=1,320) were identified and matched to 1,319 claims from the survived patients (n=1,319). The majority were men (68%) and mean age was 56.7±6.4 years. The LOS per claim for the deceased cohort was 47% higher (adjusted incidence rate ratio: 1.47, 95% confidence interval: 1.37–1.57) compared with claims from the survived cohort. Compared with the survived cohort, the adjusted mean incremental total cost of ACS admission claims from the deceased cohort was US$43,107±US$3,927 (95% confidence interval: US$35,411–US$50,803) higher. Conclusion: Despite decreasing ACS hospitalizations, the economic burden of inpatient death remains high. Keywords: death, acute coronary syndrome, hospitalization, cost, health resource utilization

Introduction: Most economic analyses that have addressed the costs associated with acute coronary syndromes (ACS) have only focused on patients who have survived an inpatient admission. No studies have specifically addressed the cost of dying during an ACS inpatient admission in a commercially insured population. Methods: Medical and pharmacy claims from the Truven MarketScan databases (2009-2011) were used to identify inpatient admissions with a primary discharge diagnosis of ACS, among patients with 6 months of continuous enrollment prior to admission. Admissions with a discharge status of “death” (deceased sample) were matched (1:3 ratio) to remaining admissions (survived sample) on age, gender, year, and Charlson Comorbidity Index (CCI), creating a matched sample. Mean length of stay, total admission cost, and mean costs per day for the deceased sample were compared to thesurvived sample. All costs are reported in 2012 USD. Results: A total of 1,160 ACS admissions with deceased discharge status were identified and matched to 3,480 ACS admissions with non-deceased (survived) status. The majority of patients were male (68%) with a mean age of 56.7±6.4 years and mean CCI ranging from 1.94-1.97. The Table summarizes a description of the ACS admissions. The average length of stay for ACS admissions with deceased status (days) were 34% higher compared to those with survived status (6.9±9.2 versus 5.2±4.8 days, respectively, p Conclusion: ACS admissions with deceased status are both expensive and longer in duration compared to those with survived status . These data can provide financial insights to hospitals regarding their case mix for resource allocation in managing their ACS population.