Healthcare utilization and costs associated with treatment for opioid dependence

Figures & data

Figure 1. Patient attrition.

Table 1. Baseline demographics and clinical characteristics.

Characteristics	XR-NTX (n = 1,041)	BUP (n = 20,566)	MET (n = 745)	NPT (n = 6,883)	p-value XR-NTX vs BUP	p-value XR-NTX vs MET	p-value XR-NTX vs NPT
Age (years), mean (SD)	29.9 (10.93)	35.8 (12.46)	37.9 (13.03)	33.2 (13.43)	<.001	<.001	<.001
Gender, n (%)
Male	718 (69.0)	13,150 (63.9)	444 (59.6)	2,679 (38.9)	.001	<.001	<.001
Female	323 (31.0)	7,416 (36.1)	301 (40.4)	4,204 (61.1)
Region, n (%)
Northeast	265 (25.5)	5,675 (27.6)	158 (21.2)	2,264 (32.9)	.028	.036	<.001
North Central	220 (21.1)	4,304 (20.9)	142 (19.1)	1,421 (20.7)
South	328 (31.5)	6,836 (33.2)	242 (32.5)	1,937 (28.1)
West	225 (21.6)	3,666 (17.8)	202 (27.1)	1,235 (17.9)
Unknown	3 (0.3)	85 (0.4)	1 (0.1)	26 (0.4)
Health plan type, n (%)
Comprehensive	27 (2.59)	632 (3.07)	16 (2.15)	228 (3.3)	<.001	.013	<.001
PPO	636 (61.10)	12,316 (59.89)	490 (65.77)	4,174 (60.6)
HMO	96 (9.22)	2,585 (12.57)	57 (7.65)	910 (13.2)
POS	112 (10.76)	1,880 (9.14)	100 (13.42)	646 (9.4)
Other	150 (7.59)	1,826 (8.88)	72 (9.66)	689 (10.0)
Unknown	20 (1.48)	1,327 (6.45)	10 (1.34)	236 (3.4)
Quan-Charlson comorbidity score, mean (SD)	0.3 (0.78)	0.3 (0.84)	0.3 (1.03)	0.4 (0.90)	.850	.521	.080
Elixhauser comorbidity score, mean (SD)	2.6 (1.57)	2.0 (1.56)	1.5 (1.48)	2.4 (1.72)	<.001	<.001	<.001
Psychiatric comorbidities, n (%)
Alcohol dependence	293 (28.1)	1,559 (7.6)	21 (2.8)	1,345 (19.5)	<.001	<.001	<.001
Anxiety disorder	440 (42.3)	5,821 (28.3)	129 (17.3)	2,394 (34.8)	<.001	<.001	<.001
Bipolar disorder	141 (13.5)	1,536 (7.5)	31 (4.2)	740 (10.8)	<.001	<.001	.008
Cannabis dependence	166 (15.9)	886 (4.3)	13 (1.7)	922 (13.4)	<.001	<.001	.026
Cocaine dependence	72 (6.9)	405 (2.0)	9 (1.2)	332 (4.8)	<.001	<.001	.004
Dementias	3 (0.3)	21 (0.1)	0 (0.0)	7 (0.1)	.079	.143	.114
Depression	496 (47.6)	6,599 (32.1)	133 (17.9)	2,814 (40.9)	<.001	<.001	<.001
Nicotine dependence	311 (29.9)	3,998 (19.4)	111 (14.9)	1,549 (22.5)	<.001	<.001	<.001
PTSD	50 (4.8)	432 (2.1)	21 (2.8)	293 (4.3)	<.001	.034	.420
Schizophrenia	4 (0.4)	103 (0.5)	4 (0.5)	64 (0.9)	.601	.634	.075
Sedative, hypnotic or anxiolytic dependence	150 (14.4)	964 (4.7)	17 (2.3)	726 (10.5)	<.001	<.001	.002
Sleep disorder	35 (3.4)	866 (4.2)	19 (2.6)	278 (4.0)	.181	.323	.296
Other comorbidities, n (%)
Hepatitis B	3 (0.3)	31 (0.2)	2 (0.3)	7 (0.1)	.275	.938	.114
Hepatitis C	39 (3.7)	590 (2.9)	40 (5.4)	217 (3.2)	.100	.100	.313
HIV	4 (0.4)	57 (0.3)	4 (0.5)	25 (0.4)	.525	.634	.917
Opiates and related narcotic poisoning	77 (7.4)	469 (2.3)	10 (1.3)	250 (3.6)	<.001	<.001	<.001
Number of psychiatric medications, mean (SD)	5.8 (4.86)	4.8 (4.3)	4.1 (3.91)	3.1 (2.07)	<.001	<.001	<.001

Abbreviations. SD, Standard deviation; XR-NTX, extended-release naltrexone; BUP, Buprenorphine; MET, Methadone; NPT, Non-pharmacological therapy; PPO, Preferred Provider Organization; HMO, Health Maintenance Organization; POS, Point of Service; PTSD, Post-traumatic Stress Disorder; HIV, Human Immunodeficiency Virus.

p-values based on t-test and Chi-square/Fisher’s exact test, where applicable.

Table 2. Healthcare resource utilization during baseline and follow-up periods.

Utilization category	XR-NTX (n = 1,041)			BUP (n = 20,566)			MET (n = 745)			NPT (n = 6,883)
	Baseline	Follow-up	Change	Baseline	Follow-up	Change	Baseline	Follow-up	Change	Baseline	Follow-up	Change
Inpatient admissions, mean (SD)	1.15 (1.34)	0.61 (1.14)	−46.6%*	0.43 (0.90)	0.34 (0.87)	−20.8%*	0.25 (0.70)	0.20 (0.61)	−23.2%	0.75 (1.07)	0.63 (1.13)	−15.1%*
OUD-related	0.54 (0.86)	0.25 (0.64)	−53.9%*	0.15 (0.47)	0.12 (0.51)	−20.0%*	0.08 (0.37)	0.03 (0.19)	−59.0%*	0.27 (0.58)	0.27 (0.69)	+0.7%
Non-OUD related	0.61 (1.07)	0.36 (0.86)	−40.2%*	0.28 (0.73)	0.22 (0.66)	−21.5%*	0.18 (0.54)	0.16 (0.54)	−8.0%	0.48 (0.92)	0.36 (0.87)	−24.3%*
Detox and/or rehab	0.91 (1.16)	0.45 (0.93)	−50.6%*	0.25 (0.60)	0.19 (0.61)	−25.3%*	0.13 (0.51)	0.06 (0.33)	−50.0%*	0.48 (0.77)	0.44 (0.92)	−8.1%*
Inpatient, days, mean (SD)	11.55 (16.43)	4.99 (10.38)	−56.8%*	3.02 (7.72)	2.75 (8.61)	−8.8%*	1.65 (6.04)	1.41 (5.64)	−14.8%	6.05 (11.00)	6.01 (11.96)	−0.6%
OUD-related	6.40 (12.55)	2.34 (7.21)	−63.5%*	1.24 (4.81)	1.25 (5.82)	+0.8%	0.66 (4.19)	0.41 (2.78)	−38.9%	2.32 (6.57)	2.96 (8.25)	+27.7%*
Non-OUD related	5.15 (11.59)	2.65 (7.16)	−48.4%*	1.78 (5.71)	1.50 (5.82)	−15.5%*	0.99 (3.57)	1.00 (4.32)	+1.4%	3.73 (9.07)	3.05 (8.67)	−18.1%*
Detox and/or rehab	10.13 (15.42)	4.12 (9.53)	−59.3%*	2.01 (6.10)	1.89 (7.36)	−5.9%*	1.01 (5.10)	0.67 (3.84)	−33.8%	4.43 (9.32)	4.92 (10.91)	+11.1%*
ED visits, mean (SD)	1.27 (2.22)	0.94 (2.39)	−26.1%*	1.06 (2.68)	0.92 (2.54)	−13.3%*	0.89 (2.14)	0.82 (1.53)	−8.6%	1.33 (2.54)	1.12 (2.96)	−15.5%*
OUD-related	0.18 (0.90)	0.12 (1.37)	−34.4%*	0.07 (0.36)	0.06 (0.97)	−10.0%	0.04 (0.23)	0.02 (0.16)	−65.1%*	0.09 (0.40)	0.12 (1.60)	+30.0%
Non-OUD related	1.09 (2.02)	0.82 (1.94)	−24.7%*	0.99 (2.63)	0.86 (2.30)	−13.5%*	0.85 (2.10)	0.80 (1.49)	−5.8%	1.24 (2.49)	1.01 (2.39)	−18.7%*
Outpatient visits, mean (SD)	35.55 (32.21)	44.32 (41.21)	+24.7%*	18.36 (19.90)	30.87 (26.95)	+68.1%*	22.52 (34.89)	66.48 (78.01)	+195.2%*	22.83 (23.95)	44.02 (37.89)	+92.8%*
Office visits	15.39 (15.74)	20.94 (19.20)	+36.1%*	11.69 (13.10)	19.19 (16.81)	+64.2%*	12.56 (23.55)	39.10 (60.40)	+211.2%*	12.73 (15.60)	20.19 (22.60)	+58.6%*
Outpatient hospital	12.33 (19.30)	13.41 (22.19)	+8.7%	3.88 (8.14)	6.05 (12.43)	+55.8%*	4.79 (13.72)	14.34 (41.38)	+199.1%*	6.26 (10.93)	15.07 (21.43)	+140.7**
Laboratory	3.78 (7.92)	5.65 (13.01)	+49.3%*	1.34 (3.36)	3.57 (7.14)	+166.3%*	0.80 (2.21)	1.40 (4.45)	+75.9%*	1.71 (4.34)	4.22 (10.24)	+147.0%*
Other outpatient	4.05 (9.15)	4.33 (11.46)	+7.0%	1.45 (4.09)	2.06 (6.21)	+42.6%*	4.37 (18.85)	11.64 (41.22)	+166.4%*	2.13 (5.50)	4.54 (10.43)	+112.8%*
Pharmacy fills, mean (SD)	28.65 (26.30)	32.44 (25.64)	+13.2%*	25.90 (27.65)	38.97 (28.86)	+50.5%*	21.75 (30.24)	64.89 (76.99)	+198.4%*	24.33 (30.39)	25.26 (30.57)	+3.9%*

Abbreviations. SD, Standard deviation; XR-NTX, extended-release naltrexone; BUP, Buprenorphine; MET, Methadone; NPT, Non-pharmacological therapy.

*p < .05.

p-values for difference between baseline and follow-up periods based on paired t-test.

Table 3. Healthcare costs during baseline and follow-up periods.

Cost category	XR-NTX (n = 1,041)			BUP (n = 20,566)			MET (n = 745)			NPT (n = 6,883)
	Baseline	Follow-up	Change	Baseline	Follow-up	Change	Baseline	Follow-up	Change	Baseline	Follow-up	Change
Inpatient admissions, mean (SD)	$12,099 (19,818)	$6,437 (15,462)	−46.8%*	$4,518 (13,196)	$4,110 (13,136)	−9.0%*	$3,034 (11,196)	$3,142 (13,825)	+3.6%	$7,579 (15,633)	$7,634 (16,650)	+0.7%
OUD-related	$5,507 (13,179)	$1,986 (7,231)	−63.9%*	$1,004 (4,345)	$980 (4,992)	−2.4%	$514 (3,276)	$225 (1,611)	−56.2%*	$1,929 (5,711)	$2,763 (8,485)	+43.2%*
Non-OUD related	$6,592 (15,106)	$4,451 (13,538)	−32.5%*	$3,514 (12,230)	$3,130 (11,967)	−10.9%*	$2,519 (10,427)	$2,917 (13,606)	+15.8%	$5,649 (14,633)	$4,871 (14,161)	−13.8%*
Detox and/or rehab	$9,306 (16,669)	$4,257 (11,811)	−54.2%*	$1,766 (5,975)	$1,636 (6,969)	−7.4%*	$850 (4,355)	$507 (3,071)	−40.3%	$3,759 (8,314)	$4,747 (11,835)	+26.3%*
ED visits, mean (SD)	$1,329 (2,815)	$959 (2,399)	−27.8%*	$1,012 (3,058)	$897 (2,803)	−11.3%*	$763 (1,973)	$806 (2,190)	+5.7%	$1,352 (3,045)	$1,130 (3,073)	−16.4%*
OUD-related	$181 (814)	$113 (625)	−37.9%*	$65 (408)	$47 (384)	−28.5%*	$43 (293)	$14 (162)	−67.2%*	$95 (515)	$67 (467)	−29.4%*
Non-OUD related	$1,147 (2,667)	$847 (2,296)	−26.2%*	$946 (3,004)	$850 (2,748)	−10.1%*	$720 (1,911)	$792 (2,178)	+10.1%	$1,258 (2,979)	$1,063 (3,009)	−15.5%*
Outpatient visits, mean (SD)	$14,926 (22,482)	$19,003 (25,300)	+27.3%*	$5,650 (10,882)	$8,737 (14,096)	+54.6%*	$4,290 (9,818)	$8,278 (10,152)	+93%*	$8,251 (14,214)	$15,679 (24,191)	+90.0%*
Office visits	$2,689 (4,280)	$6,399 (7,456)	+137.9%*	$1,820 (3,060)	$3,082 (4,289)	+69.3%*	$1,664 (4,028)	$3,972 (3,662)	+138.7%*	$2,051 (3,644)	$3,178 (5,995)	+54.9%*
Outpatient hospital	$8,309 (15,905)	$7,862 (15,601)	−5.4%	$2,682 (7,517)	$3,582 (9,443)	+33.6%*	$1,844 (6,351)	$2,758 (6,980)	+49.5%*	$4,391 (9,870)	$8,281 (15,827)	+88.6%*
Laboratory	$1,408 (4,891)	$2,411 (8,683)	+71.3%*	$350 (1,702)	$1,091 (3,543)	+211.6%*	$151 (823)	$278 (1,430)	+84.9%*	$515 (2494)	$1,682 (7,318)	+226.2%*
Other outpatient	$2,520 (8,276)	$2,331 (7,633)	−7.5%	$798 (3,627)	$982 (4,534)	+23.1%*	$631 (3,053)	$1,270 (5,331)	+101.4%*	$1,294 (5,032)	$2,537 (8,267)	+96.1%*
Pharmacy costs, mean (SD)	$2,464 (4,323)	$5,973 (8,146)	+142.4%*	$2,617 (4,960)	$5,987 (6,764)	+128.8%*	$1,134 (4,528)	$1,395 (3,925)	+23%	$2,149 (5,742)	$2,397 (7,113)	+11.5%*
Total costs, mean (SD)	$30,817 (35,240)	$32,372 (33,756)	+5.0%	$13,797 (22,123)	$19,731 (23,953)	+43.0%*	$9,220 (18,479)	$13,621 (19,935)	+47.7%*	$19,331 (26,383)	$26,839 (34,263)	+38.8%*

Abbreviations. SD, Standard deviation; XR-NTX, extended-release naltrexone; BUP, Buprenorphine; MET, Methadone; NPT, Non-pharmacological therapy.

*p < .05.

p-values for difference between baseline and follow-up periods based on paired t-tests.

Table 4. Treatment patterns during the follow-up period.

Treatment patterns	XR-NTX (n = 1,041)	BUP (n = 20,566)	MET (n = 745)	p-value XR-NTX vs BUP	p-value XR-NTX vs MET
Adherence
MPR, Mean (SD)	0.48 (0.28)	0.69 (0.33)	0.47 (0.40)	<.001	.090
PDC, Mean (SD)	0.44 (0.25)	0.66 (0.32)	0.44 (0.37)	<.001	.240
Persistence (in days)
≥45-days gap, Mean (SD)	161.5 (106.48)	249.3 (134.64)	235.03 (135.89)	<.001	<.001

Abbreviations. SD, Standard deviation; XR-NTX, extended-release naltrexone; BUP, Buprenorphine; MET, Methadone; NPT, Non-pharmacological therapy; PDC, Proportion of days covered; MPR, Medication possession ratio.

p-values based on linear regression analyses after controlling for baseline covariates.

Figure 2. Difference in healthcare costs during baseline and follow-up periods: between groups comparisons. Abbreviations. XR-NTX, extended-release naltrexone; BUP, Buprenorphine; MET, Methadone; NPT, Non-pharmacological therapy; ED, Emergency department. Reference category: XR-NTX. *denote significant difference when compared with XR-NTX at p < .05. p-values were based on generalized linear models (GLM) with a log-link function and gamma distribution after controlling for baseline covariates.