Abatement Costs

The implications of the cost analysis presented in this chapter can be summarized as follows. First and foremost, the two methods together provide a range of what could be considered reasonable, with the low end of the range being national ten-year abatement-related costs of $10,524.95 million and the high end of the range being $16,377.81 million, reflective of what could be considered an attributable cost ceiling. The second implication is that studies of the attributable costs of opioids reach remarkably consistent findings, even across different methodological approaches. Although there are some common methodological challenges to the design and conduct of studies of attributable costs, the fact that these studies reached such similar conclusions suggests that these limitations probably did not result in substantial biases. If there is a consistent bias, it is likely in the direction of overestimation of costs due to the methodological issues discussed earlier in the chapter. The third important implication is that several adjustments are required to bring national estimates in line with attributable costs faced by state and local governments. For healthcare, the adjustment is substantial due to the cost sharing arrangements between Medicaid and the federal government. The other adjustments are equally important. Adjusting for the share of opioids sourced from the health care system is necessary to keep the focus on prescription opioids, especially in recent years and going forward as the share of prescription opioids continues to decline and the share of illicit opioids grows. Finally, calculating attributable cost and abatement cost ceilings have intuitive appeal because the approaches employed by plaintiffs in abatement calculations are likely to represent unreasonably high estimates, and the cost ceiling approaches are a means by which to check for face validity. In just two Ohio counties, excluding Medicaid-covered healthcare costs, plaintiff demands reached more than $3 billion, which represents about 20% of the cost attributable ceiling total derived from published cost estimates for the entire U.S., even with healthcare costs included in the published estimates, and about 30% of the total national estimated ten-year abatement cost ceiling. Again, as of 2020, based on the CDC data referenced earlier, these counties had 0.0625% and 0.0563% shares of national opioid prescriptions, respectively. Hence, based on the national abatement cost ceiling, and applying these opioid prescription volume weights, abatement costs would be $6.6 million and $5.9 million for the two counties, respectively. Like the findings from the attributable cost model, these amounts are less than 1% of the plaintiff estimated abatement costs.