Comparison of Rates of Overdose and Hospitalization After Initiation of Medication for Opioid Use Disorder in the Inpatient vs Outpatient Setting

Morgan, Jake R.; Barocas, Joshua A.; Murphy, Sean M.; Epstein, Rachel; Stein, Michael D.; Schackman, Bruce R.; Walley, Alexander Y.; Linas, Benjamin P.

doi:10.1001/jamanetworkopen.2020.29676

Cited by 22 publications

(16 citation statements)

References 25 publications

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“…10,28 Notably, detoxification and inpatient treatment, common points of initial treatment-seeking for individuals with OUD, are expensive, and associated costs may deter seeking outpatient follow-up. 29,30 While these services are important for some individuals, it is possible to initiate MOUD in an outpatient setting first. Delivery systems and benefit designs should be redesigned to promote low-threshold MOUD initiation and uptake.…”

Section: Discussionmentioning

confidence: 99%

Variation in Initiation, Engagement, and Retention on Medications for Opioid Use Disorder Based on Health Insurance Plan Design

et al. 2022

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Background: The association between cost-sharing and receipt of medication for opioid use disorder (MOUD) is unknown.Methods: We constructed a cohort of 10,513 commercially insured individuals with a new diagnosis of opioid use disorder and information on insurance cost-sharing in a large national deidentified claims database. We examined 4 cost-sharing measures: (1) pharmacy deductible; (2) medical service deductible; (3) pharmacy medication copay; and (4) medical office copay. We measured MOUD (naltrexone, buprenorphine, or methadone) initiation (within 14 d of diagnosis), engagement (second receipt within 34 d of first), and 6-month retention (continuous receipt without 14-d gap). We used multivariable logistic regression to assess the association between cost-sharing and MOUD initiation, engagement, and retention. We calculated total out-of-pocket costs in the 30 days following MOUD initiation for each type of MOUD.Results: Of 10,513 individuals with incident opioid use disorder, 1202 (11%) initiated MOUD, 742 (7%) engaged, and 253 (2%) were

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Section: Discussionmentioning

confidence: 99%

Variation in Initiation, Engagement, and Retention on Medications for Opioid Use Disorder Based on Health Insurance Plan Design

et al. 2022

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“…Similarly, in communities that already link some patients from detox directly to community care, it is important to ensure that efforts to expand MOUD in detox sustain similar linkage to care rates, because the cost‐effectiveness of MOUD in detox decreases when linkage from detox falls. Plans to offer MOUD in detox centers must include careful thought about linking patients to outpatient care [44].…”

Section: Discussionmentioning

confidence: 99%

Population‐level impact of initiating pharmacotherapy and linking to care people with opioid use disorder at inpatient medically managed withdrawal programs: an effectiveness and cost‐effectiveness analysis

et al. 2022

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Background and Aims Medications for opioid use disorder (MOUD) are shown to reduce opioid use and the risk of overdose. People with opioid use disorder (OUD) who exit inpatient medically managed withdrawal programs (detox) without initiating MOUD and linking to outpatient care have high rates of overdose. While detox encounters provide a theoretical opportunity for MOUD initiation, this is not ubiquitous in the United States. We used simulation modeling to estimate the population‐level health effects and cost‐effectiveness of a policy encouraging MOUD initiation during inpatient detox encounters. Design, Setting and Participants We employed a dynamic population state‐transition model to evaluate the effectiveness and cost‐effectiveness of using detox programs as venues for initiating MOUD in Massachusetts, United States. We compared standard of care, where no detox patients initiate MOUD or link to outpatient MOUD providers, to strategies of offering MOUD to detox patients and linking those patients to outpatient MOUD. Measures Budgetary impact to the Massachusetts health‐care sector, incremental cost‐effectiveness ratios (ICER) and total counts and percentage differences of fatal overdoses prevented. Findings Initiating MOUD in detox with perfect linkage to outpatient MOUD would reduce fatal overdoses by 4.5% [95% confidence interval (CI) = 2.3–5.9], at an ICER of $56 000 per quality‐adjusted life‐year (QALY) gained, compared with the standard of care. With moderate linkage, fatal overdoses would be reduced by 2.3% (95% CI= 1.2–3.1) with an ICER of $78 500 per QALY gained, compared with standard of care. Budgetary increase to Massachusetts health‐care spending ranged from 0.5–1%. Conclusion A simulation model indicates that initiation of medications for opioid use disorder and linkage policies among detox patients in Massachusetts, USA could prevent fatal opioid overdoses in the opioid use disorder population and would be cost‐effective from a health‐care sector perspective.

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“…While naloxone is pharmacologically effective for reversing opioid overdoses and saving lives, previous research suggests that interventions addressing the underlying cause of the overdose, such as medications for opioid use disorder, are necessary and effective in the long term ( Linas et al, 2021 ). Unless interventions are in place to support those who were rescued from a fatal overdose in managing their use disorder, the risk of a subsequent overdose remains ( Morgan et al, 2020a , 2020b ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Rates of Overdose and Hospitalization After Initiation of Medication for Opioid Use Disorder in the Inpatient vs Outpatient Setting

Abstract: This comparative effectiveness research study uses 2010-2017 data from the MarketScan Commercial Claims and Encounters Database to compare the rates of opioid-related overdose and all-cause hospitalization after treatment of opioid use disorder in outpatient vs inpatient care settings.

Cited by 22 publications

References 25 publications

Variation in Initiation, Engagement, and Retention on Medications for Opioid Use Disorder Based on Health Insurance Plan Design

Variation in Initiation, Engagement, and Retention on Medications for Opioid Use Disorder Based on Health Insurance Plan Design

Population‐level impact of initiating pharmacotherapy and linking to care people with opioid use disorder at inpatient medically managed withdrawal programs: an effectiveness and cost‐effectiveness analysis

The role of increasing pharmacy and community distributed naloxone in the opioid overdose epidemic in Massachusetts, Rhode Island, and New York City

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