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

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

2014 Postgrad Med

Khemiri, A. | Kharitonova, E. | Zah, V. | Ruby, J. | Toumi, M. | Volume: 126, Issue: 5, Pages: 113-20, Adult, Age Factors, Buprenorphine/*economics/*therapeutic use, Buprenorphine, Naloxone Drug Combination, Comorbidity, Dose-Response Relationship, Drug, Female, Health Expenditures/statistics & numerical data, Health Services/economics/statistics & numerical data, Humans, Insurance Claim Review/*statistics & numerical data, Insurance, Health/statistics & numerical data, Kaplan-Meier Estimate, Male, Medication Adherence, Mental Disorders/epidemiology, Naloxone/*economics/*therapeutic use, Opiate Substitution Treatment/*economics, Opioid-Related Disorders/*drug therapy/epidemiology, Recurrence, Retrospective Studies,

OBJECTIVES: The buprenorphine/naloxone combination is used to treat the chronic relapsing disorder of opioid dependence. Adequate dosing levels are important to control cravings, prevent withdrawal syndrome, and maintain patients in treatment. The objective of this study was to estimate the impact of dosing on treatment persistence, resource utilization, and total direct health care costs. METHODS: A retrospective cohort analysis was performed using administrative claims extracted from the MarketScan and Clinformatics databases from January 2007 to June and November 2012. Patients initiating treatment with buprenorphine/naloxone were classified into 2 groups based on the prescribed average dose over the entire treatment period and matched by multiple criteria. The threshold for differentiating the dosing groups was set at 15 and 15.7 mg/day for publicly and privately insured patients, respectively. Resource utilization and related costs were calculated over the 12-month period after the treatment initiation. RESULTS: Patient characteristics at baseline were considerably different between the privately and publicly insured patients. Publicly insured patients were slightly younger (33.1 vs 34.3 years old for privately insured) and had a higher prevalence of mental disorders (70.9% vs 64.9%). In both groups, patients treated with higher doses (> 15 mg and > 15.7 mg per day for publicly and privately insured patients, respectively) had lower risk of discontinuation (public: 11% lower; private: 9% lower) and lower probability of a psychiatric hospitalization than patients treated with lower doses (public: 17% lower; private: 41% lower). Total costs were comparable between the 2 groups (public: $14 600; private: $21 000) despite the expected higher cost of pharmacy in the higher-dose group. CONCLUSIONS: 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.

https://www.doi.org/10.3810/pgm.2014.09.2805