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Quantifying the benefits of urine tests

November 17, 2011
by Gary A. Enos, Editor
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Acost-benefit analysis released in the fall enumerates some significant financial benefits for regular urine drug testing for patients receiving treatment for chronic pain. Conducted by the economic research and consulting firm Laffer Associates, the analysis found that if a clinically accepted standard of two to six urine tests are administered for these patients each year, about $2.32 to $4.31 in benefits is achieved for every dollar spent on testing.

Laffer Associates researchers used data from drug testing company Millennium Laboratories to conduct the analysis, which is believed to break new ground in examining both the costs and benefits of testing specifically for the chronic pain treatment population. Achieving better outcomes in pain treatment and avoiding improper use of opioid medications amount to significant goals in that persistent chronic pain costs U.S. society more than $323 billion a year, according to the report.

“Our hypothesis was that the benefits of testing were going to outweigh the costs, and this result undoubtedly shows that,” says Wayne Winegarden, PhD, principal of Laffer Associates and principal investigator of the study. “Testing becomes a valuable tool in helping doctors with opioid prescriptions.”

Numerical findings

Although urine testing affords physicians an opportunity to obtain within minutes some important information on whether a pain patient is taking medications as directed, the report states, “The benefits associated with the rapid increase in medication monitoring utilization must be balanced against their associated expenditures in light of limited resources available for medical care.”

The Laffer Associates team led by Winegarden adds that for urine testing to become accepted practice on a widespread basis, it must demonstrate both medical benefits and financial benefits when costs are included in the analysis.

The cost-benefit analysis was based on a representative patient with chronic pain receiving prescribed opioid medication and two to six urine tests over one year. Based on Millennium Laboratories data involving more than 260,000 patients, it was estimated that two to six quantitative tests would improve a patient's adherence to prescribed medication by 3.8 to 10.5 percent. Going to the higher number of 12 tests in a year would improve the adherence rate by 18.4 percent, according to the analysis.

“Is there evidence that urine drug tests are changing behavior? The answer is yes,” Winegarden says.

The analysis placed the per-unit cost of the urine tests at $211 to $363. This total includes the costs of a preliminary immunoassay screen conducted in a physician's office and confirmatory testing conducted by a laboratory, as well as any other testing deemed necessary in individual cases.

Analysts then looked at the benefits derived from testing and its effect of improving patient compliance with medication regimens. The benefits can be seen along multiple dimensions, according to the analysis. Among the key areas are improved productivity in the workplace (with estimated gains of $290 to $797 per patient per year based on two to six drug tests) and savings to the healthcare system (in an estimated range of $429 to $1,184 per patient per year based on two to six tests).

The Laffer Associates team also looked at regular drug testing's effects on social costs associated with pain medication misuse, including criminal justice costs stemming from drug-related crime and lost productivity as a result of premature deaths from drug overdoses.

When looking at all costs and benefits in the aggregate, the researchers calculated a 2.5 to 4.3 benefit-to-cost ratio range in cases where two tests a year are administered, and a 2.3 to 4.0 benefit-to-cost ratio range in cases where six tests a year are given. “Over the entire pain population, this equates to $7.4 billion to $25.7 billion in aggregate benefits from two to six [tests] per year,” the report states.

The researchers added that even if the social benefits of testing are not taken into consideration, the benefits that relate directly to better pain management for individuals alone exceed the costs of administering the regular tests.

Selecting a number

Winegarden says that the optimal number of tests that should be administered as part of any given pain patient's treatment over a year is of course a medical question. But the range commonly seen for many individuals in the Millennium database that the analysis used certainly appears to have value from the cost-benefit analysis's standpoint.

The benefits would not simply continue to accrue with higher and higher numbers of tests administered, Winegarden adds. Costs would begin to outweigh benefits if tests were administered several times a week, for example-and of course there would be logistical hurdles to that extent of testing as well.

The analysis concluded, “These results suggest that a properly structured health care plan should be able to capture the potential benefits of a [urine drug test] program, while generating additional benefits to patients, physicians and society at large.”

Addiction Professional 2011 November-December;9(6):56