Costs of care for persons with opioid dependence in commercial integrated health systems

Abstract

BackgroundWhen used in general medical practices, buprenorphine is an effective treatment for opioid dependence, yet little is known about how use of buprenorphine affects the utilization and cost of health care in commercial health systems.MethodsThe objective of this retrospective cohort study was to examine how buprenorphine affects patterns of medical care, addiction medicine services, and costs from the health system perspective. Individuals with two or more opioid-dependence diagnoses per year, in two large health systems (System A: n = 1836; System B: n = 4204) over the time span 2007–2008 were included. Propensity scores were used to help adjust for group differences.ResultsPatients receiving buprenorphine plus addiction counseling had significantly lower total health care costs than patients with little or no addiction treatment (mean health care costs with buprenorphine treatment = $13,578; vs. mean health care costs with no addiction treatment = $31,055; p < .0001), while those receiving buprenorphine plus addiction counseling and those with addiction counseling only did not differ significantly in total health care costs (mean costs with counseling only: $17,017; p = .5897). In comparison to patients receiving buprenorphine plus counseling, those with little or no addiction treatment had significantly greater use of primary care (p < .001), other medical visits (p = .001), and emergency services (p = .020). Patients with counseling only (compared to patients with buprenorphine plus counseling) used less inpatient detoxification (p < .001), and had significantly more PC visits (p = .001), other medical visits (p = .005), and mental health visits (p = .002).ConclusionsBuprenorphine is a viable alternative to other treatment approaches for opioid dependence in commercial integrated health systems, with total costs of health care similar to abstinence-based counseling. Patients with buprenorphine plus counseling had reduced use of general medical services compared to the alternatives.

Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis

“…We do not report the number or proportion of participants endorsing themes because access to buprenorphine was limited by regulations that changed over the course of the study, and because adoption proceeded differently and at different paces in the two health plans (Green et al, 2014; Lynch et al, 2014). In addition, methadone treatment was covered in only one of the two plans.…”

“…This paper’s qualitative analysis of patient interviews complements prior analyses of service use (McCarty et al, 2010), costs of care (Lynch et al, 2014), and clinician and health system administrator perspectives (Green et al, 2014). …”

A Systematic, Intensive Statistical Investigation of Data from the Comprehensive Analysis of Reported Drugs (CARD) for Compliance and Illicit Opioid Abstinence in Substance Addiction Treatment with Buprenorphine/naloxone

“…Opioid-use disorder is associated with many adverse, health and social consequences for society: infectious disease transmission, elevated healthcare costs, public disorder, crime and fatal overdose (Lynch et al, 2014). A combination of buprenorphine a partial mu-receptor combination.…”

Advanced Practice Nurses: Increasing Access to Opioid Treatment by Expanding the Pool of Qualified Buprenorphine Prescribers

“…Yet, other practitioners who hold a DEA license, notably advanced practice nurses, cannot prescribe buprenorphine, even as the benefits and cost savings of buprenorphine treatment for opioid use disorders are clear. [8][9][10][11] This past August, a bipartisan group of 13 US senators sent a letter to the Secretary of Health and Human Services, urging increased access to buprenorphine treatment in the face of the opioid epidemic, and specifically requesting consideration for nurse practitioners and physician assistants to join physicians in prescribing buprenorphine. 12 This editorial is an appeal for all advanced practice nurses with appropriate prescriptive privileges and DEA licenses to be allowed to join physicians in prescribing buprenorphine to increase access to opioid agonist treatment and to reduce the harms associated with the opioid epidemic.…”