期刊
MEDICAL CARE
卷 58, 期 10, 页码 919-926出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MLR.0000000000001394
关键词
opioid use disorder; comparative cost analysis; treatment
类别
资金
- Massachusetts General Hospital from the National Institutes of Health National Institute of Drug Abuse [1R01DA044526-01A1, 3UG1DA015831-17S2]
- Substance Abuse and Mental Health Services Administration [1H79TI081442-01]
- Health Resources and Services Administration [1T25HP37602-01]
- Laura and John Arnold Foundation
- Boston University School of Public Health
- American Physical Therapy Association
- Boston School of Public Health from the National Institutes of Health (NIH) [P30 AG13846, 1U01AA021989, R01 AR055557]
- NIH via the National Institute of Neurological Disorders and Stroke [1U01NS093334-01, 1U01NS086659]
- NIH via the National Institute on Alcohol Abuse and Alcoholism [U24 AA020779, 1R01AA021335]
- National Institute of Allergy and Infectious Diseases [U01 AA020776]
- NIH via the National Institute on Deafness and Other Communication Disorders [P50 DC013027]
- NIH via the National Center for Advancing Translational Sciences [1UL1TR001430]
- NIH via the National Institute on Minority Health and Health Disparities [U24 MD006964]
- NIH via the National Institute on Drug Abuse [R01DA032082, R01 DA037768]
- Department of Defense [W81XWH-13-2-0072]
- Boston Medical Center from the National Institutes of Health via the National Institute on Drug Abuse [K23DA042168, UM1DA049412]
- National Center for Advancing Translational Sciences [1UL1TR001430]
- Centers for Disease Control and Prevention [U01CE002780]
- Food and Drug Administration [HHSF2232009100006I]
- Office of National Drug Control Policy/University of Baltimore [G1799ONDCP06B]
- Boston University School of Medicine Department of Medicine Career Investment Award
- Optum-UnitedHealth Group
- Department of Veterans Affairs
- Optum via UnitedHealthcare
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.
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