Downloaded from http://journals.lww.com/joem by BhDMf5ePHKbH4TTImqenVBaqevB2sTM0izaH7ZvQ0CN1jEewJrFaOBN7Txzyc0mf on 06/17/2020 Copyright © 2020 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited Opioid Use Disorder and Employee Work Presenteeism, Absences, and Health Care Costs Rachel Mosher Henke, PhD, David Ellsworth, MS, Lauren Wier, DrPH, and Jane Snowdon, PhD Objective: To measure the prevalence of opioid use disorder (OUD) and employee health care and productivity costs with and without OUD and to assess whether utilization of pharmacotherapy for OUD reduces those costs. Methods: We conducted a cross-sectional analysis of 2016 to 2017 com- mercial enrollment, health care, and pharmacy claims and health risk assessment data using the IBM 1 MarketScan 1 Databases (Ann Arbor, MI). We estimated regression models to assess the association between OUD and annual employee health care and productivity costs. Results: Health care and productivity costs for employees with OUD who did and did not receive pharmacotherapy were approximately $6294 and $21,570 more than for other employees, respectively. Conclusions: Employers can make a business case for expanding access to pharmacotherapy treatment for OUD based on our finding that receipt of pharmacotherapy significantly reduces overall health care costs. Keywords: absenteeism, caregiving, employer, healthcare costs, opioid use disorder, pharmacotherapy, presenteeism E mployee health can affect employer health care and productiv- ity costs. 1–3 Employers, particularly self-insured employers, increasingly are concerned specifically about the costs associ- ated with opioid misuse among their employees. Individuals prescribed opioids are at risk for dependence, 4–6 and many employees receive such prescriptions. Doctors prescribe pain- killers to nearly 40% of individuals who seek help for lower back pain, one of the most common workplace ailments. 7 Although opioid prescribing to adolescents is rare, dependents of employees are at risk for misusing opioids from leftover prescriptions. 8 Prior research has measured the impact of employee opioid use disorder (OUD) on employer costs. 9–11 One study found that employees who are dependent on opioids but have not been diagnosed with OUD have lower at-work productivity, which costs employers approximately $16 million a year. 9 Another study using 2006 to 2012 data reported that individuals with OUD had seven more medically related absenteeism days annu- ally relative to matched controls. 12 A third study found that US adults who misuse prescription pain relievers have higher work absenteeism than do employees who do not. 13 Studies focusing on health care costs have found that individuals who misuse opioids have more than $10,000 more in annual expendi- tures. 12,14–16 Employers do not have a recent or full picture of costs related to OUD. Employees who have a spouse or dependent with an OUD may have additional lost productivity days and days absent because of family member health concerns. Employees may have to help their family member navigate health care benefits during business hours, including identifying appropriate and available providers for substance use disorder (SUD). Employees also may assume a caregiving role, particularly during relapse or potential relapse. A cross-sectional study of caregivers of individuals with advanced cancer found a 23% drop in average productivity. 17 Another study that looked at caregivers of patients with poststroke spasticity found that lost-productivity cost per employed caregiver was $835 per month, with 72% attributable to presenteeism. 18 As payers, employers have the opportunity to improve access to OUD treatment by covering pharmacotherapy such as methadone, buprenorphine/naloxone, and naltrexone as part of their health care benefits. The use of these Food and Drug Administration-approved pharmacotherapies, in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of OUD. Not all people with OUD seek treatment, but those who do seek treatment do not necessarily receive this evidence-based treatment for multiple reasons— including stigma, cost, and lack of available providers. Health- plan restrictions such as limited provider networks, prior autho- rization, counseling requirements, quantity limits, step therapy requirements, duration limitations, and network requirements also are obstacles to access for many. 19 Treatment admissions data show that only 18% of people admitted for prescription OUD have a treatment plan that includes pharmacotherapy. 20 Employ- ers that already cover these pharmacotherapies can invest in efforts to increase awareness and uptake of these important treatment options. In making these decisions, employers need to consider the business case for these investments, such as whether pharmacotherapies increase or decrease total health care expenditures. In this study, we describe the prevalence of OUD among employees and their spouses and dependents. We measure the association of employee OUD and presenteeism, health-related absences, and health care costs. We also examine whether family member health affects these outcomes and whether receipt of pharmacotherapy to treat OUD reduces days lost to absences, preseenteism, or health care costs associated with OUD. Finally, Learning Objectives  Review previous evidence on employer costs associated with opioid use disorder (OUD).  Summarize the findings of the new analysis of the impact of OUD on employee healthcare and productivity costs.  Discuss the findings on the cost impact of pharmacotherapy for employees with OUD. From the IBM Watson Health, Cambridge, MA (Dr Henke, Ellsworth, Wier, Snowdon); and CVS Health, Rhode Island, Woonsocket (Dr Wier). Funding: IBM Watson Health. Authors are employees of IBM Watson Health. Henke, Ellsworth, Wier, and Snowdon have no relationships/conditions/circum- stances that present potential conflict of interest. The JOEM editorial board and planners have no financial interest related to this research. Clinical significance: Pharmacotherapy was associated with significantly lower health care and productivity costs for employees with opioid use disorder. On the basis of this finding, employers can make a business case for expanding access to pharmacotherapy treatment. Supplemental digital contents are available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.joem.org). Address correspondence to: Rachel Mosher Henke, PhD, IBM Watson Health, 75 Binney St, Cambridge, MA 02142 (Rachel.henke@us.ibm.com). Copyright ß 2020 American College of Occupational and Environmental Medicine DOI: 10.1097/JOM.0000000000001830 344 JOEM  Volume 62, Number 5, May 2020 CME AVAILABLE FOR THIS ARTICLE AT ACOEM.ORG