(292) Adverse Pregnancy Outcomes with Stimulant and Opioid Use Disorder: Costs of Care and Health-system Implications

This study was undertaken to identify the current public health cost burden of inpatient hospitalizations for adverse pregnancy outcomes (APO) in the context of stimulant and opioid use disorder (OUD).

Study Design:

We conducted a cross-sectional analysis of inpatient delivery admissions from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2016 to 2019. APO was defined as a composite to include hypertensive disorders, antepartum or postpartum hemorrhage, preterm birth, and fetal growth restriction. Inpatient delivery admissions of patients with a stimulant or OUD and concomitant APO diagnosis were identified from NIS using ICD-10 codes and diagnosis related group (DRG) codes. Our primary outcome was total charges of the hospital stay with inflation related adjustments. Survey-weighted means and the percentage of change in total charges over time was calculated and compared across study years.

Results:

Inpatient delivery related hospitalizations for APO with stimulant or OUD increased from 2,212 in 2016 to 3616 in 2019. The median hospital charges for admissions with APOs with stimulant use disorder had an 8% increase ($22,108 to $23,827) and those with OUD had a 6% increase ($20,226 to $21,452) from 2016 to 2019. In comparison, delivery admissions with APOs in the absence of stimulant or OUD were noted to have a 1% increase ($21,686 to $21,965) from 2016 to 2019. Evaluation of the aggregate charges and costs, or the “National Bill” revealed that in 2019 the total costs of hospitalizations with APOs with stimulant use disorder was $8,727,192 and with OUD was $9,258,586. The total cost increase for inpatient management of APOs with stimulant use disorder was nearly 3 million dollars compared to an increase of 2 million dollars with OUD from 2016 to 2019 (Figure 1).

Conclusion:

Our work provides an appreciation of the cost burden from APOs associated with opioid and stimulant use disorder, as an essential first step for designing system-level interventions for addressing the escalating costs of care associated with perinatal substance use disorder.