Importance A persistently high US drug overdose death toll and increasing health care use associated with substance use disorder (SUD) create urgency for comprehensive estimates of attributable direct costs, which can assist in identifying cost-effective ways to prevent SUD and help people to receive effective treatment.

Objective To estimate the annual attributable medical cost of SUD in US hospitals from the health care payer perspective.

Design, Setting, and Participants This economic evaluation of observational data used multivariable regression analysis and mathematical modeling of hospital encounter costs, controlling for patient demographic, clinical, and insurance characteristics, and compared encounters with and without secondary SUD diagnosis to statistically identify the total attributable cost of SUD. Nationally representative hospital emergency department (ED) and inpatient encounters from the 2017 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample were studied. Statistical analysis was performed from March to June 2020.

Exposures International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) principal or secondary SUD diagnosis on the hospital discharge record according to the Clinical Classifications Software categories (disorders related to alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, and other substances).

Main Outcomes and Measures Annual attributable SUD medical cost in hospitals overall and by substance type (eg, alcohol). The number of encounters (ED and inpatient) with SUD diagnosis (principal or secondary) and the mean cost attributable to SUD per encounter by substance type are also reported.

Results This study examined a total of 124 573 175 hospital ED encounters and 33 648 910 hospital inpatient encounters from the 2017 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample. Total annual estimated attributable SUD medical cost in hospitals was $13.2 billion. By substance type, the cost ranged from $4 million for inhalant-related disorders to $7.6 billion for alcohol-related disorders.

Conclusions and Relevance This study’s results suggest that the cost of effective prevention and treatment may be substantially offset by a reduction in the high direct medical cost of SUD hospital care. The findings of this study may inform the treatment of patients with SUD during hospitalization, which presents a critical opportunity to engage patients who are at high risk for overdose. Aligning incentives such that prevention cost savings accrue to payers and practitioners that are otherwise responsible for SUD-related medical costs in hospitals and other health care settings may encourage prevention investment.

重要性 美国药物滥用造成的死亡人数持续增加以及与药物使用障碍（SUD）相关的医疗保健使用不断增加，因此迫切需要对可归因的直接费用进行全面估计，这可以帮助您确定具有成本效益的方法来预防SUD并帮助人们获得有效的治疗方法。治疗。

目的 从医疗保健付款人的角度估算美国医院SUD的年度可归因医疗费用。

设计，设置和参加者 这项对观察数据的经济评估使用了医院遭遇成本的多变量回归分析和数学模型，控制了患者的人口统计，临床和保险特征，并比较了具有或不具有二次SUD诊断的遭遇，以统计学方式确定总归因SUD的成本。研究了全国代表性的医院急诊科（ED），并研究了2017年医疗保健成本和使用项目全国急诊科样本和国家住院病人样本中的住院情况。从2020年3月至2020年6月进行了统计分析。

曝光 疾病的国际统计分类，第十次修订本，临床修正（ICD-10-CM）根据与酒精，大麻，致幻剂，吸入剂，阿片类药物的临床分类软件类别（病症在出院记录主要或次要SUD诊断，镇静剂，兴奋剂和其他物质）。

主要成果和措施 整体上和按物质类型（例如，酒精）在医院中应占的SUD年度医疗费用。还报告了按SUD诊断（主要或继发）的遭遇次数（急诊和住院）以及每次遭遇SUD的平均费用（按物质类型划分）。

结果 该研究共检查了2017年医疗保健成本和利用项目全国急诊室样本和国家住院样本中的124 573 175例医院ED遭遇和33 648 910例住院患者。医院每年可归因的SUD医疗费用估计为132亿美元。按物质类型，费用从与吸入器相关的疾病的400万美元到与酒精相关的疾病的76亿美元不等。

结论与相关性 这项研究的结果表明，有效预防和治疗的费用可能会因SUD医院护理的直接医疗高昂费用的减少而基本抵销。这项研究的发现可能会为住院期间SUD患者的治疗提供参考，这为吸引高剂量过量风险患者提供了重要的机会。调整激励措施，使在医院和其他医疗机构中应承担与SUD相关的医疗费用的付款人和从业人员可以节省预防费用，这可能会鼓励预防投资。