Relationship between buprenorphine adherence and relapse, health care utilization and costs in privately and publicly insured patients with opioid use disorder

Abstract

Background

Treatment for opioid use disorder is important because of the negative health, societal and economic consequences of illicit opioid use, but treatment adherence can be a challenge. This study assessed the association between buprenorphine medication-assisted treatment (MAT) adherence and relapse, health care utilization and costs.

Patients and methods

Patients with opioid use disorder who were newly initiating a buprenorphine MAT regimen were identified in the 2008–2014 MarketScan^® Commercial and Medicaid Databases and followed for 12 months after their earliest outpatient pharmacy claim for buprenorphine. Adherence was categorized using proportion of days covered (PDC) with buprenorphine, and patients with PDC≥0.80 were classified as adherent. Descriptive and adjusted analyses compared relapse prevalence, utilization and costs, all measured in the 12 months following buprenorphine MAT initiation, of adherent patients to patients in non-adherent PDC categories (PDC<0.20, 0.20≤PDC<0.40, 0.40≤PDC<0.60, 0.60≤PDC<0.80).

Results

Adherent patients were 37.1% of the Commercial sample (N=16,085) and 41.3% of the Medicaid sample (N=5,688). In both samples, non-adherent patients were significantly more likely than adherent patients to relapse and to have hospitalizations and emergency department visits. As a result, as buprenorphine MAT adherence increased, pharmacy costs increased, but medical costs decreased. Total costs (pharmacy plus medical costs) in the 12 months following buprenorphine MAT initiation decreased with adherence in Commercial patients ($28,525 for PDC<0.20 to $17,844 for PDC≥0.80). A slight decrease in total costs in the 12 months following buprenorphine MAT initiation was also observed in Medicaid patients ($21,292 for PDC<0.20 to $18,621 for PDC≥0.80). After adjustment, total costs of adherent patients in the Commercial sample ($17,519) were significantly lower compared with those of non-adherent patients (range $20,294–$24,431). In the Medicaid sample, adjusted total costs were not significantly different between adherence groups.

Conclusion

Buprenorphine MAT adherence in the 12 months following treatment was associated with reduced odds of relapse and reduced unadjusted medical costs. For Commercial patients who were adherent to treatment, the adjusted total costs were predicted to be 30% lower than those for patients with PDC<0.20.

Keywords:

• buprenorphine
• adherence
• opioid use disorder
• relapse
• utilization
• costs

Acknowledgments

The authors thank the following Truven Health Analytics^® (Cambridge, MA, USA) employees for their contributions: Ashley Cole who was responsible for SAS programming and data management and Kavya Thelakkat who contributed to the manuscript preparation.

Disclosure

This study was funded by Indivior Inc, (Richmond, VA). BAW, MD, received funding from Indivior Inc. for his role as a project consultant and previously served on Indivior-sponsored advisory boards. VRN and NAR are employees of Indivior Inc. LBM is an employee of Truven Health Analytics^®, part of the IBM Watson Health™ business, which received funding from Indivior Inc. to conduct this analysis. TMW was an employee of Truven Health Analytics when this study was conducted and is currently at the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA. The authors report no other conflicts of interest in this work. Portions of this study were presented at the Academy of Managed Care Pharmacy (AMCP) Nexus Conference, National Harbor, MD, USA, October 3–6, 2016 and the US Psychiatric and Mental Health Congress, San Antonio, TX, USA, October 21–24, 2016.