<b><i>Objectives:</i></b> Buprenorphine (BUP) is used in opioid maintenance treatment (OMT) for opioid-dependent patients. Previous real-world evidence suggests that many patients receive lower BUP dosage than recommended, with 38% of patients receiving &#x3c;6 mg BUP per day. The goal of this research is to evaluate the impact of BUP dosage on the risk of relapses in the real world. <b><i>Methods:</i></b> This study was based on German claims data of 4 million patients. Patients identified by International Classification of Diseases, 10th Edition F11.2 (opioid dependence) between 2011 and 2012 and at least one BUP prescription were selected for this study (<i>n</i> = 364) and followed up over 4 years. Patients were assigned to 6 dosage groups, with &#x3c;6 mg/day serving as low dosage/reference category. The impact of dosage on the occurrence of relapses (indicated by treatment interruption of &#x3e;3 months without OMT prescription or hospital admissions) was examined using multivariate logistic regression. Age, gender, comorbidities, fixed/variable dosing, and up-dosing were used as covariates. <b><i>Results:</i></b> Results showed a protective effect of higher BUP as higher BUP dosages were significantly associated with a lower risk of relapse. Using low dosage (&#x3c;6 mg/day) as the reference category, ORs were 0.40 (95% CI 0.19–0.87) at 6–&#x3c;8 mg/day, 0.28 (0.15–0.56) at 8–&#x3c;10 mg/day, 0.26 (0.10–0.67) at 10–&#x3c;12 mg/day, 0.40 (0.18–0.92) at 12–&#x3c;16 mg/day, and 0.18 (0.09–0.37) at ≥16 mg/day. No covariate showed a significant effect on the probability of relapse. <b><i>Conclusions:</i></b> The present study used a large German health claims dataset to confirm that higher BUP dosages are a protective factor for avoiding relapses in opioid-dependent patients, thus highlighting the importance of adequate BUP dosing in relapse prevention.

BackgroundOpioid Use Disorder (OUD) is a substance use disorder with a chronic course associated with comorbid mental and somatic disorders, a high burden of psychosocial problems and opioid maintenance treatment (OMT) as a standard treatment. In the US, OUD imposes a significant economic burden on society, with annual societal costs estimated at over 55 billion dollars. Surprisingly, in Europe and especially in Germany, there is currently no detailed information on the healthcare costs of patients with OUD. The goal of the present research is to gather cost information about OUD patients in OMT with a focus on maintenance medication and relapses.MethodsWe analysed health claims data of four million persons covered by statutory health insurance in Germany, applying a cost-of-illness approach and aimed at examining the direct costs of OMT patients in Germany. Patients with an ICD-10 code F11.2 and at least one claim of an OMT medication were stratified into the treatment groups buprenorphine, methadone or levomethadone, based on the first prescription in each of the follow-up years. Costs were stratified for years with and without relapses. Group comparisons were performed with ANOVA.ResultsWe analysed 3165 patient years, the total annual sickness funds costs were on average 7470 € per year and patient. Comparing costs of levomethadone (8400 €, SD: 11,080 €), methadone (7090 €, SD: 10,900 €) and buprenorphine (6670 €, SD: 7430 €) revealed significant lower costs of buprenorphine compared to levomethadone (p < 0.0001). In years with relapses, costs were higher than in years without relapses (8178 € vs 7409 €; SD: 11,622, resp. 10,378 €). In years with relapses, hospital costs were the major cost driver.ConclusionsThe present study shows the costs of OUD patients in OMT for the first time with a German dataset. Healthcare costs for patients with an OUD in OMT are associated with more than two times the cost of an average German patients. Preventing relapses might have significant impact on costs. Patients in different OMT were dissimilar which may have affected the cost differences.

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The intervention scenario models a hypothetical situation when every patient starts receiving treatment shortly after the disease onset. Under both scenarios, individual lifetime costs are estimated for a set of patient profiles differing in sex and the age at which the disease develops. These costs are then compared per profile to evaluate the economic impact of early treatment. Model parameters are based on national registers (probability of treatment and hospitalization), life tables (probability of death), published research on domestic costs of care, and foreign schemes of cognitive decline. RESULTS: Early treatment decreases societal costs by thousands of euros per patient's lifetime. The savings are higher for earlier disease onsets and for women, who enjoy a longer life expectancy. For instance, the costs of a woman developing the disease at 70 decrease from V277 thousand (health care 2.9; informal care 274) under the CAU to V259 thousand (7.3; 252) under the intervention scenario. The savings diminish with the onset age but remain positive also for onsets after the 90th birthday. CONCLUSIONS: Early treatment has the potential to decrease the societal burden of AD in Czechia by prolonging the time in which patients live more independently with milder cognitive impairment. While slightly increasing spending from public health budgets, it would result in considerable savings to patients.