Substance use disorder medical costs in the US employer-sponsored insured population exceed $35 billion

According to researchers in a study published in JAMA Network Open. Researchers used recent financial transactions—total inpatient, total outpatient, and outpatient drug costs of ESI enrollees with SUDs—to estimate that private insurance paid $1.1 trillion in total personal health care costs in the US in 2018.

“Among ESI participants with SUD, this analysis extends what is known about imputed costs in the ESI population,” the study authors wrote in a recent paper. “Strategies to assist employees and their dependents in the prevention and treatment of SUDs can be considered in terms of potentially offsetting the existing high medical costs of SUDs.”

From 2001 to 2020, people aged 20 to 64 accounted for over 90% of deaths from drug or alcohol poisoning. By 2020, 11% of older workers in the US reported having an SUD, with more than 50% of average employers suggesting that opioids have affected their workplace.

The study aimed to understand how workplaces are affected by SUDs. They conducted an economic evaluation from the perspective of health care payers by estimating applicable annual medical costs for SUDs in the ESI population.

The primary endpoint looked at total annual SUD medical costs in the ESI population and annual SUD medical costs by substance type in the ESI population. Researchers also reported mean annual costs per diagnosed SUD and mean annual costs per affected participant by substance type.

The researchers looked at 162 million non-Medicare ESI enrollees taken from Merative MarketSacan 2018 databases. The team used different types of modeling to estimate medical costs, comparing costs between enrollees with and without a SUD diagnosis.

In 2018, annual medical costs for the 1.4% (2.3 million) of ESI enrollees diagnosed with SUDs were $35.3 billion. Alcohol use disorder is the costliest, contributing $10.2 billion to total annual medical costs. Opiate use disorder patients also contributed $7.3 billion to total annual medical costs.

“More than half of enrollees with a diagnosis of SUD had an alcohol-related disorder, and nearly 30% had an opiate-related disorder,” the researchers wrote in the paper.

Alcohol- and opioid-related disorders were associated with high average inpatient treatment costs of $3988 and $3570 per participant, respectively. Outpatient costs averaged $4875 and $6280, and the average total cost per patient was $8939 and $11871, respectively.

The data also led researchers to suggest that employers and health insurance payers paid medical costs that were higher than reported in the study. This was based on results showing that 1% of the ESI population was diagnosed with SUD, although 11% of workers self-reported having SUD.

The study is not without limitations. First, the reported cost estimate covers people with insurance but not those with self-care. Furthermore, they could not accurately match specific comorbidities to enrollees, nor did they use weighted regression analysis or estimate SUD costs among different demographics in a subgroup analysis.

“Employers can take action by developing workplace-supported prevention, treatment, and recovery programs,” the study authors wrote in their analysis.


Roberts T, Kesselheim A, Avorn J. Variation in use of targeted lung cancer therapies in state Medicaid programs, 2020-2021. JAMA Netw Open. 2023;6(1):e2252562. doi:10.1001/jamanetworkopen.2022.52562

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