Analysis of Buprenorphine/Naloxone Dosing Impact on Treatment Duration, Resource Use and Costs in the Treatment of Opioid-Dependent Adults: A Retrospective Study of US Public and Private Health Care Claims

Abstract

Treatment with higher doses of buprenorphine/naloxone was associated with a longer time to treatment discontinuation, less resource use, and lower total medical costs despite higher pharmacy acquisition cost.

Three-year retention in buprenorphine treatment for opioid use disorder nationally in the Veterans Health Administration

“…In prior reports from clinical trials data, buprenorphine treatment retention varied from 20% at 52 weeks to 53% at 1 year and 25% at 2 years in more recent studies . One‐year retention rates reported from naturalistic studies are generally lower than in the VHA sample reported here, with 32–57% in small practice settings, just above 20% in a national program in Australia, and 42–45% in insurance claims data based studies from United States (about 20% retention after 3 years) . Comprehensive Statewide implementation of office based opioid treatment in Massachusetts in 2012 showed a 1‐year retention rate in buprenorphine OAT of 65%, the only report that approached retention rates reported here .…”

“…Several limitations deserve note. We lacked data on dose strength of buprenorphine, duration, and severity of OUD, type of opioid used or psychosocial factors, which can all influence treatment retention . We also did not have information on treatment interruptions, although we think such interruptions do not diminish the importance of evidence of sustained involvement.…”

“…A recent literature review showed that few studies have reported buprenorphine retention beyond 6 months, and the scant studies with longer term information include data for only up to 1 year . Two recent insurance claims‐based studies focusing on healthcare costs presented data on treatment retention, but lacked clinical information on patient characteristics that are associated with retention …”

Economic Evaluations of Opioid Use Disorder Interventions

“…Khemiri et al[46] conducted a retrospective cohort analysis of US beneficiaries with an opioid use disorder who were enrolled in a commercial healthcare insurance plan or in Medicaid, and who had a new buprenorphine/naloxone prescription with at least 1 refill. Individuals receiving low-dose BMT were compared to those receiving high-dose BMT.…”

“…Other outcomes of interest included lower criminal-justice-related costs associated with methadone maintenance therapy (MMT),[39] lower costs associated with buprenorphine/naloxone film versus tablets,[44, 45] and improved retention for high-dose versus low-dose buprenorphine/naloxone patients, with no significant increase in total direct healthcare costs. [46]…”