Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder: A Cohort Study.
Adolescent
Adult
Aged
Ambulatory Care
/ economics
Behavior Therapy
/ economics
Buprenorphine
/ therapeutic use
Cohort Studies
Female
Health Care Costs
Hospitalization
/ economics
Humans
Male
Medicare
Methadone
/ therapeutic use
Middle Aged
Naltrexone
/ therapeutic use
Narcotic Antagonists
/ therapeutic use
Opiate Substitution Treatment
/ economics
Opioid-Related Disorders
/ drug therapy
Retrospective Studies
United States
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
pubmed:
26
8
2020
medline:
3
11
2020
entrez:
26
8
2020
Statut:
ppublish
Résumé
Relative costs of care among treatment options for opioid use disorder (OUD) are unknown. We identified a cohort of 40,885 individuals with a new diagnosis of OUD in a large national de-identified claims database covering commercially insured and Medicare Advantage enrollees. We assigned individuals to 1 of 6 mutually exclusive initial treatment pathways: (1) Inpatient Detox/Rehabilitation Treatment Center; (2) Behavioral Health Intensive, intensive outpatient or Partial Hospitalization Services; (3) Methadone or Buprenorphine; (4) Naltrexone; (5) Behavioral Health Outpatient Services, or; (6) No Treatment. We assessed total costs of care in the initial 90 day treatment period for each strategy using a differences in differences approach controlling for baseline costs. Within 90 days of diagnosis, 94.8% of individuals received treatment, with the initial treatments being: 15.8% for Inpatient Detox/Rehabilitation Treatment Center, 4.8% for Behavioral Health Intensive, Intensive Outpatient or Partial Hospitalization Services, 12.5% for buprenorphine/methadone, 2.4% for naltrexone, and 59.3% for Behavioral Health Outpatient Services. Average unadjusted costs increased from $3250 per member per month (SD $7846) at baseline to $5047 per member per month (SD $11,856) in the 90 day follow-up period. Compared with no treatment, initial 90 day costs were lower for buprenorphine/methadone [Adjusted Difference in Differences Cost Ratio (ADIDCR) 0.65; 95% confidence interval (CI), 0.52-0.80], naltrexone (ADIDCR 0.53; 95% CI, 0.42-0.67), and behavioral health outpatient (ADIDCR 0.54; 95% CI, 0.44-0.66). Costs were higher for inpatient detox (ADIDCR 2.30; 95% CI, 1.88-2.83). Improving health system capacity and insurance coverage and incentives for outpatient management of OUD may reduce health care costs.
Sections du résumé
BACKGROUND
Relative costs of care among treatment options for opioid use disorder (OUD) are unknown.
METHODS
We identified a cohort of 40,885 individuals with a new diagnosis of OUD in a large national de-identified claims database covering commercially insured and Medicare Advantage enrollees. We assigned individuals to 1 of 6 mutually exclusive initial treatment pathways: (1) Inpatient Detox/Rehabilitation Treatment Center; (2) Behavioral Health Intensive, intensive outpatient or Partial Hospitalization Services; (3) Methadone or Buprenorphine; (4) Naltrexone; (5) Behavioral Health Outpatient Services, or; (6) No Treatment. We assessed total costs of care in the initial 90 day treatment period for each strategy using a differences in differences approach controlling for baseline costs.
RESULTS
Within 90 days of diagnosis, 94.8% of individuals received treatment, with the initial treatments being: 15.8% for Inpatient Detox/Rehabilitation Treatment Center, 4.8% for Behavioral Health Intensive, Intensive Outpatient or Partial Hospitalization Services, 12.5% for buprenorphine/methadone, 2.4% for naltrexone, and 59.3% for Behavioral Health Outpatient Services. Average unadjusted costs increased from $3250 per member per month (SD $7846) at baseline to $5047 per member per month (SD $11,856) in the 90 day follow-up period. Compared with no treatment, initial 90 day costs were lower for buprenorphine/methadone [Adjusted Difference in Differences Cost Ratio (ADIDCR) 0.65; 95% confidence interval (CI), 0.52-0.80], naltrexone (ADIDCR 0.53; 95% CI, 0.42-0.67), and behavioral health outpatient (ADIDCR 0.54; 95% CI, 0.44-0.66). Costs were higher for inpatient detox (ADIDCR 2.30; 95% CI, 1.88-2.83).
CONCLUSION
Improving health system capacity and insurance coverage and incentives for outpatient management of OUD may reduce health care costs.
Identifiants
pubmed: 32842044
doi: 10.1097/MLR.0000000000001394
pmc: PMC7641182
pii: 00005650-202010000-00011
doi:
Substances chimiques
Narcotic Antagonists
0
Buprenorphine
40D3SCR4GZ
Naltrexone
5S6W795CQM
Methadone
UC6VBE7V1Z
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
919-926Subventions
Organisme : NIAAA NIH HHS
ID : U24 AA020779
Pays : United States
Organisme : NIDA NIH HHS
ID : UM1 DA049412
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS086659
Pays : United States
Organisme : NINDS NIH HHS
ID : U01 NS093334
Pays : United States
Organisme : NIAAA NIH HHS
ID : U01 AA020776
Pays : United States
Organisme : NIAAA NIH HHS
ID : R01 AA021335
Pays : United States
Organisme : NIDA NIH HHS
ID : K23 DA042168
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA044526
Pays : United States
Organisme : NIDCD NIH HHS
ID : P50 DC013027
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001430
Pays : United States
Organisme : NIAAA NIH HHS
ID : U01 AA021989
Pays : United States
Organisme : FDA HHS
ID : HHSF223200910006I
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA032082
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG013846
Pays : United States
Organisme : NCIPC CDC HHS
ID : U01 CE002780
Pays : United States
Organisme : NIDA NIH HHS
ID : UG1 DA015831
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA037768
Pays : United States
Organisme : NIMHD NIH HHS
ID : U24 MD006964
Pays : United States
Organisme : NIAMS NIH HHS
ID : R01 AR055557
Pays : United States
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