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OBJECTIVE:The aim of this study was to evaluate medical and pharmaceutical costs and health outcomes among commercially insured members treated for hepatitis C virus (HCV) infections from a large, academic institution. METHODS:Data are derived from the University of Texas System (UT SELECT) medical and pharmacy claims database. This study is a retrospective claims analysis of secondary, deidentified data from 2006 to 2016. RESULTS:The number of HCV-infected and treated patients decreased from 22.5 per 10,000 members in 2006 to 0.15 per 10,000 members in 2016 (P < 0.0001). Medical and pharmacy paid per member per month (PMPM) costs were highest among HCV-infected members with advanced liver disease (total paid PMPM = $2737, medical PMPM = $1537, pharmacy PMPM = $1200). CONCLUSIONS:The declining prevalence of acute HCV infections and the introduction of efficacious HCV treatment options for chronic HCV in this commercial population have resulted in significant reductions in HCV-related medical claims and the clinical sequelae of advanced liver diseases. Although HCV treatment to achieve sustained viral response remains expensive, the prevention of advanced liver disease decreased system-wide medical costs for this insured population.

Physical therapy (PT) is perceived as a cost driver in the US workers’ compensation system. We conducted a 5-year (2013 to 2017) retrospective analysis utilizing 192,197 claims from a large Texas based workers’ compensation insurance company to describe the relationship between the amount of physical therapy delivered and workers’ compensation costs and lost-time. Closed, indemnity claims with 15 or more PT visits were six times more likely (95% confidence interval [CI]5.50, 86.58) to result in high medical costs (>$7000, excluding PT costs) and were four times more likely (95% CI3.77, 4.42) to result in more than or equal to 6 months of lost-time, when controlling for confounders. When the number of PT visits more than or equal to 15 visits for a lost time claim, this level of PT exceeds all other predictors (opioid use, comorbidities, legal involvement, surgery, etc) of medical cost and extended time out from work.

OBJECTIVE:The aim of this study is to examine health-related quality of life (HRQOL) among U.S. injured workers using a longitudinal study of a nationally representative sample. METHODS:Employed adults with and without occupational injuries from the 2000 to 2011 Medical Expenditure Panel Survey (MEPS) were included. Outcomes were the physical and mental components of the SF-12. A within-person change using paired tests and a between-person change using multivariable regression were performed. RESULTS:We estimate over 1.6 million injured workers per year. Sprains were the most common injury. Relative to noninjured workers, injured workers reported 3.0 and 1.0 points lower physical and mental component scores, respectively. CONCLUSIONS:These results confirm that occupational injuries cause significant deficits in the physical component of HRQOL. This highlights the importance of preventing occupational injuries to reduce associated disabilities in the U.S.

BACKGROUND:Antidepressants, benzodiazapines, and opioid medications are used to manage the pain, anxiety, or depression associated with workplace injuries. OBJECTIVE:To evaluate the impact of these medications on workers’ compensation costs and time lost from work. METHODS:A cohort of 22,383 indemnity claims from 2008 to 2013 were evaluated for the association of prescribed medications on claim cost and delayed claim closure controlling for confounders. RESULTS:Claims with anti-depressant, opioid, or benzodiazepine prescriptions were 2.24 (95% CI2.00 to 2.51), 1.14 (95% CI1.02 to 1.27), and 1.38 (95% CI1.23 to 1.54) times more likely to remain open at the end of the study. CONCLUSION:The concurrent treatment of pain, depression or anxiety, and occupational injuries are associated with large increases in claim cost and delayed return to work.

BACKGROUND:The financial impact regarding choice of physician within the workers’ compensation domain has not been well studied. OBJECTIVE:The aim of this study was to assess the difference in claim cost between employee- and employer-directed choice of treating physician after injury. METHODS:Thirty-five thousand six hundred forty indemnity lost time claims from a 13-year period at a nationwide company were analyzed with multivariate logistic regression to determine the association of medical direction with risk of high-cost claims. RESULTS:States that have employer-directed physician choice were associated with a lower risk of having high-cost claims (≥$50,000) but higher attorney involvement than employee direction. The net effect of this enhanced presence of attorneys offsets the benefits of employer choice of treating physician. CONCLUSION:States that permit employer selection of treating physician have slightly higher cost due to the higher prevalence of attorney involvement in the claims process.

BACKGROUND:Work-related injuries in the U.S. have steadily declined over the past three decades. OBJECTIVE:The aim of this study was to compare trends of the most frequently injured body parts from a beverage company over an 8-year study period (2008 to 2015). METHOD:Work-related injury claims with more than 3 days of missed work (N = 20,203) were classified into body part groups, including low back, knee, shoulder, and all other(s). Descriptive statistics and linear models were used to evaluate trends over time. RESULTS:The total number of injuries decreased from 6.57 per 100 to 3.79 per 100 employees from 2008 to 2015. Proportion of low back injuries decreased from 22.0% to 15.4% (P < 0.001) over the study period. Proportionally, knee(s), shoulder(s), and all other injuries increased, but the changes did not reach statistical significance. CONCLUSION:Low back injuries decreased at a faster rate than knee, shoulder, and all other injuries.

OBJECTIVE:The aim of this study was to assess the relationship between timing and duration of opioid prescriptions, disability duration, and claims costs for work-related injuries. METHOD:A retrospective cohort study using lost time compensation claimant data to examine the relationship between opioid prescription patterns and claim duration and cost. Logistic regression adjusted for sex, marital status, initial reserve, attorney involvement, and spinal surgeries. RESULTS:Odds ratios for claim cost at least $100,000 and duration at least 3 years were not statistically different between groups prescribed opioids less than 30 days and those not prescribed opioids. Claims with short-acting opioids continued after 180 days; the odds ratios for claim cost at least $100,000 and duration at least 3 years were 6.21 (95% confidence interval 5.30 to 7.28) and 3.32 (95% confidence interval 2.94 to 3.74). CONCLUSION:Claim cost and lost time are related to when and how long opioids are prescribed for work-related injuries.

OBJECTIVE:The aim of this study was to identify a simple surrogate to predict the future risk of multiple lost-time injuries. METHOD:Employees of an academic medical center who sustained 5,906 injuries were followed from 1994 to 2017 or 1,046,218 person years. RESULTS:The odds ratio of having three or more lost-time injuries during their entire duration of employment was 2.12 (95% confidence interval1.60 to 2.79) for employees having their first lost-time injury within the first 6 months of employment versus those injured after that, controlling for demographics and employment duration. For each increasing year before the first lost-time injury, the probability of having three or more lost-time injuries decreased by 13%. CONCLUSIONS:Employment duration before the first lost-time injury may be used to predict future lost-time injuries without detailed information of underlying risk factors.

OBJECTIVE:This study describes the relationship between opioid prescribing and ability to work. METHODS:The opioid prescription patterns of 4994 claimants were studied. Three groups were constructed1) at least 3 consecutive months prescribed (chronic opioid therapy; COT); 2) less than 3 consecutive months prescribed (acute opioid therapy; AOT); and 3) no opioids prescribed. Variables included sex, age, daily morphine equivalent dose (MED), days opioids were prescribed, temporary total days (TTDs), and medical/indemnity/total costs. RESULTS:The COT versus AOT claimants had higher opioid costs ($8618 vs $94), longer TTD (636.2 vs 182.3), and average MED (66.8 vs 34.9). Only 2% of the COT cohort were not released to work. Fifty-seven percent of patients in the COT category (64 of 112) were released to work while still receiving opioids. CONCLUSION:COT does not preclude ability to work when prescribing within established guidelines.

Objective: Quantify temporal changes in opioid use. Methods: Claim and prescription data for Louisiana Workers' Compensation Corporation claims open from 1999 and 2009 were analyzed by claim age and type of opioid. Results: There was a significant cumulative yearly increase in morphine milligram equivalents prescribed for claimants with acute pain (55-mg increase per year), as well as chronic pain (461-mg increase per year). The cost per morphine milligram equivalent was approximately the same ($0.06 to $0.07) for long- and short-acting medications, but the medication cost was 8 times higher in claims where long-acting opioids were prescribed (with or without short-acting opioids) versus only short-acting medications. Conclusions: The annual cumulative dose and cost of opioids per claim increased over the study period related to an increase in prescriptions for long-acting opioids.