Medical Cost for Substance Use Disorder in US Employer-Sponsored Insurance Population More Than $35 Billion


Alcohol-related disorders were the most expensive substance type that contributed to total estimated medical cost.

Investigators were able to quantify the annual medical cost of substance use disorders (SUDs) among patients with employer-sponsored insurance (ESI), according to investigators in a study published in JAMA Network Open. The investigators used recent financial transactions—total inpatient, total outpatient, and outpatient drug expenditures of ESI enrollees with SUD—to estimate that private insurance paid $1.1 trillion in total US personal health care expenditures in 2018.

“Among ESI enrollees with SUD, this analysis expands what is known about attributable costs in the ESI population,” wrote study authors in a recent article. “Strategies to support employees and their health insurance dependents to prevent and treat SUDs can be considered in terms of potentially offsetting the existing high medical cost of SUDs.”

From 2001 to 2020, people aged 20 to 64 years accounted for over 90% of deaths from drug or alcohol poisoning. By 2020, 11% of US adult employees reported having an SUD, with more than 50% of mid-size employers suggesting that opioids affected their place of work.

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

The primary endpoint looked at overall annual medical costs for SUD in the ESI population, and annual SUD medical costs by substance type in the ESI population. The investigators also reported on mean annual cost per diagnosed SUD and annual mean cost per affected enrollee by substance type.

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

In 2018, the annual attributable medical cost of 1.4% (2.3 million) of ESI enrollees diagnosed with an SUD was $35.3 billion. Alcohol use disorder was the most costly, contributing $10.2 billion to the total annual medical cost. Patients with opioid use disorder contributed $7.3 billion to the total annual medical cost as well.

“More than half of enrollees with an SUD diagnosis had an alcohol-related disorder and nearly 30% had an opioid-related disorder,” investigators wrote in the article.

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

The data also led investigators to suggest that employer and health insurance payers paid medical costs that are higher than what was reported in the study. This was based on results which showed 1% of the ESI population were diagnosed with SUD, despite 11% of workers self-reporting having an SUD.

The study is not without limitations. First, the reported cost estimate cover people with insurance, but not those with self-pay services. Additionally, they could not exactly match specific comorbidities with enrollees, nor did it use a weighted regression analysis or assess SUD costs among different demographics in a subgroup analysis.

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


Roberts T, Kesselheim A, Avorn J. Variation in Use of Lung Cancer Targeted Therapies Across State Medicaid Programs, 2020-2021. JAMA Netw Open. 2023;6(1):e2252562. doi:10.1001/jamanetworkopen.2022.52562

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