Characterizing Long-Term Health Related Quality of Life Trajectories of Individuals With Opioid Use Disorder

Abstract

Objectives Health related quality of life (HRQoL) has been increasingly considered an endpoint in evaluations of treatment for substance use disorders. We aimed to characterize longitudinal patterns of HRQoL in individuals with opioid use disorder (OUD) and with a history of opioid agonist treatment (OAT) with methadone. Methods The EuroQol EQ-5D, a preference-weighted measure of HRQoL, was assessed in individuals with OUD and with a history of OAT enrolled in three prospective cohort studies between December 2011 and May 2014, with a maximum of five biannual assessments. We used latent class growth analysis to identify HRQoL trajectory classes and their association with self-reported current OAT receipt. Class assignment was derived from posterior probabilities and we explored time-invariant and time-varying determinants of trajectory class membership. Results Our study included 443 individuals (median age 47, 37% female); 24.6% reported use of illicit opioids at every follow-up, 69.1% during at least one follow-up. We identified three latent HRQoL trajectory classes that were stable regardless of current OAT receipt: stably high (n=107, 24.2%), stably moderate (n=260, 58.7%) and stably low HRQoL (n=76, 17.2%). A history of either a physical disability or of a mental health illness increased the probability of membership assignment to a lower HRQoL class. Conclusions The non-significant association of OAT with HRQoL may suggest that the modest immediate HRQoL gains after OAT engagement, observed in short-term studies, may not persist over time. Implications for cost-effectiveness analysis and clinical practice are discussed.

Health-related quality of life and opioid use disorder pharmacotherapy: A secondary analysis of a clinical trial

“…In contrast, we found psychiatric problems at baseline and recent receipt of pharmacotherapy for OUD treatment to be associated with HRQoL trajectories in at least one class. Discontinuation of pharmacotherapy for OUD was not associated with HRQoL in Nosyk (2011); Krebs et al (2016) found that pharmacotherapy for OUD was not a factor in developmental trajectories of HRQoL, while Nosyk et al (2015) found that pharmacotherapy had a positive impact on HRQoL across all sub-groups. Our results do not help to clarify these associations as we found pharmacotherapy to have a heterogenous association on HRQoL over time.…”

“…There are several sources of possible variation between our results and the previous studies noted above. First, in contrast to Nosyk et al (2011;2015) and Krebs et al (2016), we statistically defined latent class and estimated model parameters simultaneously in the GSE-RM framework. Nosyk et al (2015) relied on sub-group selection based on treatment modalities and not based on statistical methods of class assignment.…”

“…A second difference pertains to data sources. Krebs et al (2016) analyzed pooled data from multiple cohort studies of persons with OUD who had ever accessed opioid agonist therapy, and Nosyk et al (2015) analyzed data from two clinical trials that enrolled heroin or prescription opioid dependent persons; our analysis is based on a single clinical trial of BUP-NX versus XR-NTX among persons seeking treatment in an inpatient or residential setting, continuing treatment as outpatients. Finally, we were able to take advantage of more frequently collected HRQoL assessments over time than Nosyk et al (2015); and more frequently collected HRQoL assessments from a greater number of participants than Nosyk et al (2011) and Krebs et al (2016).…”

“…Characterizing subpopulations of persons with OUD can also provide useful insights for developing personcentered approaches to care (Muthén and Muthén, 2000). Recent studies analyzing HRQoL of persons with OUD have utilized latent class, finite or growth mixture models, to identify unobserved subpopulations (i.e., latent classes) whose HRQoL varies over time (De Maeyer et al, 2013;Krebs et al, 2016;Nosyk et al, 2011). These statistical models can also capture variable responses to treatment and evolution of health outcomes in clinical trials (Nagin and Odgers, 2010;Kim et al, 2016).…”

Relationship between Tobacco Use and Health-Related Quality of Life (HRQoL) among Clients in Substance Use Disorders Treatment

“…Conversely, decreases in substance use during and after treatment have been associated with improvements in HRQoL. For example, clients in treatment for opioid use disorders have shown HRQoL improvement, although this may level off over time in treatment (Karow et al 2011, Krebs et al 2016, Nosyk et al 2015). Abstinence at 6 months post-inpatient detoxification has been associated with improved quality of life in the physical, mental and relationship domains, and successful recovery has been shown to be predictive of improved HRQoL in the subsequent year (Vederhus, Birkeland, and Clausen 2016, Garner et al 2014).…”