Hospitalizations Due to Infectious Disease Complications of Drug Use in Oregon: Trends and Costs

1. Jeffrey Capizzi, Judith Leahy, Haven Wheelock, Ann Thomas, Jonathan Garcia, Sean Schafer, P. Todd Korthuis αOregon Health Authority, βOutside In, γOregon State University, δOregon Health and Science University Hospitalizations Due to Infectious Disease Complications of Drug Use in Oregon, 2008–2015 42nd Annual AMERSA Conference, San Francisco, CA November 10, 2018

2. Disclosures • Dr. Korthuis has no financial conflicts. • He serves as principal investigator for NIH-funded trials that accept manufacturer-donated buprenorphine/naloxone (from Indivior) and extended-release naltrexone (from Alkermes). • Funder: NIH National Institute on Drug Abuse (UG3DA044831, UG1DA015815)

3. Background • People who inject drugs are often hospitalized for serious bacterial infections (SBI) • Prior studies document local increases in drug-related hospitalizations,1,2 but few population-based estimates exist • The purpose of this study was to assess statewide trends in injection drug use (IDU)-related hospitalizations for SBI, diagnoses, and costs in Oregon over time. 1 Tookes H, PLOS One 2015 2 Fanucchi LC, J Addict Med 2018

4. Methods • Study Design: Retrospective cohort study • Data Source: Oregon Hospital Discharge Data • State database of all hospitalizations in Oregon, excluding VA & psychiatric hospitalizations, 2008-2015 • IDU-Related SBI Hospitalizations: • Hospitalization involving ≥ 1 ICD-9/10 codes for: • Opioids, amphetamines, cocaine, sedatives, or other drug use and • Serious bacterial infections (SBI): ≥ 1 ICD-9/10 codes for: • bacteremia\sepsis • Endocarditis • Osteomyelitis • Skin/soft tissue infection

5. Methods • Cost Measurement • Patient hospitalization charges adjusted using AHRQ hospital Cost-to-Charge ratios, and converted to 2015 U.S. dollars • Analysis: Descriptive statistics reporting trends over time

6. Patient Characteristics at First Hospitalization, 2008-2015

7. Results IDU-Related SBI Hospitalizations Account for Increasing Proportion of All Hospitalizations Over Time

8. IDU-Related SBI Hospitalizations, by Substance, 2008-2015 Opioids, n= 9,417 (62%) Cocaine, n=324 (2%) n=269 (2%) n=92 (1%) n=121 (1%) n=1,350 (9%) Amphetamines, n= 3,626 (24%)

9. Results Number of IDU-Related SBI Hospitalizations Over Time, by Drug Use

10. Results Number of IDU-Related SBI Hospitalizations Over Time, by Infection Category

11. IDU-Related SBI Hospitalizations, by County Oregon Population Density, by County High rates of IDU-related SBI hospitalizations in rural, low population density Counties.

12. Total Costs of IDU-Related SBI Hospitalizations in Oregon, Over Time* $218,987,964 $69,385,527 *Adjusted for charge-to-cost and inflation (2015 USD)

13. Limitations • Administrative claims data may misclassify hospitalizations, drug use, and infections • Likely resulting in a conservative estimate • Experience in single state may not be generalizable to other states

14. Conclusions • IDU-related SBI hospitalizations comprise an increasing proportion of all hospitalizations in Oregon • Rural counties have high rates of IDU-related SBI hospitalization • IDU-related SBI hospitalization costs increased 3.1-fold, 2008-2015 • Policies that promote drug use disorder treatment and harm reduction services may decrease hospitalization costs

15. Discussion

16. Supplemental Slides

17. Results Proportion of IDU-Related SBI Hospitalizations of All Hospitalizations Over Time, by Drug Use

18. Results Proportion of IDU-Related SBI Hospitalizations Among All Hospitalizations Over Time, by Infectious Category

19. Longer Mean Length of Stay for IDU-Related Hospitalizations

20. Increasing Proportion of Total Drives Increased Costs Proportion of SBI Total hospital days and Cost attributable to IDU hospitalizations (2015 dollars)