Association Between Buprenorphine Treatment Gaps, Opioid Overdose, and Health Care Spending in US Medicare Beneficiaries With Opioid Use Disorder

Abstract

ImportanceNonadherence to buprenorphine may increase patient risk of opioid overdose and increase health care spending. Quantifying the impacts of nonadherence can help inform clinician practice and policy.ObjectiveTo estimate the association between buprenorphine treatment gaps, opioid overdose, and health care spending.Design, Setting, and ParticipantsThis longitudinal case-control study compared patient opioid overdose and health care spending in buprenorphine-treated months with treatment gap months. Individuals who were US Medicare fee-for-service beneficiaries diagnosed with opioid use disorder who received at least 1 two-week period of continuous buprenorphine treatment between 2010 and 2017 were included. Analysis took place between January 2010 and December 2017.InterventionsA gap in buprenorphine treatment in a month lasting more than 15 consecutive days.Main Outcomes and MeasuresOpioid overdose and total, medical, and drug spending (combined patient out-of-pocket and Medicare spending).ResultsOf 34 505 Medicare beneficiaries (17 927 [520%] male; 16 578 [48.1%] female; mean [SD] age, 49.5 [12.7] years; 168 [0.5%] Asian; 2949 [8.5%] Black; 2089 [6.0%] Hispanic; 266 [0.8%] Native American; 28 525 [82.7%] White; 508 [1.5%] other race), 11 524 beneficiaries (33.4%) experienced 1 or more buprenorphine treatment gaps. Treatment gap beneficiaries, compared with nontreatment gap beneficiaries, were more likely to be younger, be male, have a disability, and be Medicaid dual-eligible while less likely to be White, close to a buprenorphine prescriber, and treated with buprenorphine monotherapy (ie, buprenorphine hydrochloride). Beneficiaries were 2.89 (95% CI, 2.20-3.79) times more likely to experience an opioid overdose during buprenorphine treatment gap months compared with treated months. During treatment gap months, spending was $196.41 (95% CI, $110.53-$282.30) more than in treated months. Patients who continued to take buprenorphine dosages of greater than 8 mg/d and 16 mg/d were 2.61 and 2.84 times more likely to overdose in a treatment gap month, respectively, while patients taking buprenorphine dosages of 8 mg/d or less were 3.62 times more likely to overdose in a treatment gap month (maintenance of >16 mg/d: hazard ratio (HR), 2.64 [95% CI, 1.80-3.87]; maintenance of >8 mg/d: HR, 2.84 [95% CI, 2.13-3.78]; maintenance of ≤8 mg/d: HR, 3.62 [95% CI, 1.54-8.50]). Buprenorphine monotherapy was associated with greater risk of overdose and higher spending during treatment gaps months than buprenorphine/naloxone.Conclusions and RelevanceMedicare patients treated with buprenorphine between 2010 and 2017 had a lower associated opioid overdose risk and spending during treatment months than treatment gap months.

Effect of a Co-Located Bridging Recovery Initiative on Hospital Length of Stay Among Patients With Opioid Use Disorder

“…Reduction in readmissions or total costs may have only accrued outside the 16-week window or when compared with readmissions across the multiple regional hospitals; such data were unavailable at the time of this publication. Recent analyses of claims data suggest that gaps in buprenorphine care are associated with increased total Medicare spending . It is also plausible that patients afforded access to addiction treatment services may have taken a greater interest in their health and were more likely to proactively seek help for emergency medical issues.…”

“…Recent analyses of claims data suggest that gaps in buprenorphine care are associated with increased total Medicare spending. 29 It is also plausible that patients afforded access to addiction treatment services may have taken a greater interest in their health and were more likely to proactively seek help for emergency medical issues. As cost benefits accrue downstream, a comprehensive understanding of the cost-effectiveness of the referral strategy is warranted to argue for reasonable reimbursement based on global patient outcomes.…”

The role of recovery peer navigators in retention in outpatient buprenorphine treatment: a retrospective cohort study

“…Given that racial/ethnic minoritized groups continue to disproportionately experience overdoses, strategies are urgently needed that increase treatment retention, while being culturally responsive, provide adequate psychosocial support, and effectively address treatment accessibility 5 , 25–27 ]. Failure to attend appointments results in gaps in buprenorphine treatment and these gaps were associated with a 1.56 to 4.3 times increased risk of overdose [ 28 ]. Non-White patients experience significantly shorter durations of continuous buprenorphine receipt than White patients and had a higher risk of complete discontinuation of buprenorphine [ 29 , 30 ].…”

Do High-Deductible Health Plans Incentivize Changing the Timing of Substance Use Disorder Treatment?

“…However, whether HDHPs lead enrollees to change the timing of SUD treatment as cost exposure diminishes later in the plan year, after enrollees may have met the deductible, is mostly unexplored in the existing literature. Since continuity of and retention in SUD treatment is associated with fewer overdoses, lower mortality, and overall better outcomes, understanding the impact of this change in cost exposure among individuals enrolled in HDHPs is particularly important (Dupouy et al, 2017; Gibbons et al, 2022; Reutch et al, 2017; Samples et al, 2020).…”