Opioid substitution therapy is associated with increased detection of hepatitis C virus infection: A 15-year observational cohort study

Larney, Sarah; Grebely, Jason; Falster, Michael O.; Swart, A.C.W.; Amin, Janaki; Degenhardt, Louisa; Burns, Lucy; Vajdic, Claire M.

doi:10.1016/j.drugalcdep.2014.12.027

Cited by 11 publications

(7 citation statements)

References 27 publications

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“…Females had increased odds of testing, and this might reflect differences in health‐seeking behaviour . That OST programmes can engage PWUD in testing has been documented in several studies . Outreach test interventions can, as we also found, increase test uptake regardless of testing method , but the observed change in drug use in our cohort makes a focus on testing in non‐OST injectors warranted.…”

Section: Discussionsupporting

confidence: 58%

Test uptake and hepatitis C prevalence in 5483 Danish people in drug use treatment from 1996 to 2015: a registry‐based cohort study

et al. 2018

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Background and aims The aims of this study were, in people in treatment for drug use in Funen, Denmark, to: (1) assess prevalence of hepatitis C virus (HCV) test uptake and prevalence of HCV; (2) identify predictors of test update and HCV infection; and (3) characterize changes between 1996 and 2015 in test uptake, HCV prevalence and drug use.Design Cohort study linking the Danish National Registry on Drug Users in Treatment to the regional hepatitis test registry and the Danish Death Certificate Registry, thus combining longitudinal data on drug use with data on HCV testing and results. Setting and participants People recorded as having received treatment for drug use between 1996 and 2015 (n = 5483) in Funen, Denmark. In the cohort, 24.8% were female, median age 23 years [interquartile range (IQR) = 20-32] at entry and 50% had self-reported injecting or had received opiate substitution therapy (OST). MeasurementsThe main outcomes were the test for HCV ever and latest HCV-RNA being positive. The main predictors were for test and infection investigated; ever receiving OST, self-reported injecting, age at entry and connection to treatment centre offering outreach hepatitis care. Findings HCV test uptake was 52% and prevalence of current HCV-RNA+ was 21% in people alive at the end of follow-up. Positive predictors of having undergone HCV testing were: receiving OST [odds ratio (OR) = 3.7; 95% confidence interval (CI) = 3.2-4.5], self-reported injecting (OR = 2.3; 95% CI = 2.0-2.7), female gender (OR = 1.7; 95% CI = 1.4-1.9) and having been connected to centres with outreach hepatitis care (OR = 1.4; 95% CI = 1.2-1.7). In people alive, HCV-RNA+ prevalence was 31% if ever on OST or self-reported injecting. Among HCV-infected people, 69% were in drug use treatment at end of follow-up. For participants entering the cohort after 2010, only 5% reported opiates as main drug of use and 17% had experience of injecting. Conclusion Among Danish people in treatment for drug use from 1996 to 2015, receiving opiate substitution therapy had the largest associating to being tested for hepatitis C virus. As opiate use is declining, adapting test strategies will be necessary.

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Section: Discussionsupporting

confidence: 58%

Test uptake and hepatitis C prevalence in 5483 Danish people in drug use treatment from 1996 to 2015: a registry‐based cohort study

et al. 2018

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“…By comparison, chronic HCV prevalence in the US is approximately 0.8% (Centers for Disease Control and Prevention (CDC), 2016). Further inquiry into the reasons behind this difference should be pursued, such as whether there is increased HCV screening for MAT patients, a possibility supported by another study (Larney, Grebely, Falster, et al, 2015), or greater referral among Medicaid beneficiaries with HCV to MAT services. Additionally, further analysis should evaluate the factors contributing to cost such as severity of HCV-associated disease and treatment-seeking patterns.…”

Section: Resultsmentioning

confidence: 99%

Impact of Medication-Assisted Treatment for Opioid Addiction on Medicaid Expenditures and Health Services Utilization Rates in Vermont

Mohlman

Tanzman

Finison³

et al. 2016

Journal of Substance Abuse Treatment

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In the face of increasing rates of overdose deaths, escalating health care costs, and the tremendous social costs of opioid addiction, policy makers are asked to address the questions of whether and how to expand access to treatment services. In response to an upward trend in opioid abuse and adverse outcomes, Vermont is investing in statewide expansion of a medication-assisted therapy program delivered in a network of community practices and specialized treatment centers (Hub & Spoke Program). This study was conducted to test the rationale for these investments and to establish a pre-Hub & Spoke baseline for evaluating the additive impact of the program. Using a serial cross-sectional design from 2008 to 2013 to evaluate medical claims for Vermont Medicaid beneficiaries with opioid dependence or addiction (6158 in the intervention group, 2494 in the control group), this study assesses the treatment and medical service expenditures for those receiving medication-assisted treatment compared to those receiving substance abuse treatment without medication. Results suggest that medication-assisted therapy is associated with reduced general health care expenditures and utilization, such as inpatient hospital admissions and outpatient emergency department visits, for Medicaid beneficiaries with opioid addiction. For state Medicaid leaders facing similar decisions on approaches to opioid addiction, these results provide early support for expanding medication-assisted treatment services rather than relying only on psychosocial, abstinence, or detoxification interventions.

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“…Previous studies have shown that age, gender and accessibility/remoteness are important covariates when examining people with OUD . Age was categorised as: <30, 30–39, 40–49 and 50+ years.…”

Section: Methodsmentioning

confidence: 99%

Reductions in emergency department presentations associated with opioid agonist treatment vary by geographic location: A retrospective study in New South Wales, Australia

Jones

Shanahan

Dobbins

et al. 2019

Drug and Alcohol Review

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Introduction and Aims It is not known if the reduction in ED use during periods of OAT occurs across urgent and low acuity presentations. We aimed to compare the incidence and costs of urgent and low acuity ED presentations of people with opioid use disorder (OUD) in and out of opioid agonist treatment (OAT). Design and Methods This was a retrospective cohort study (N=24,875), using linked administrative health data from New South Wales (NSW), Australia. Urgent and low acuity ED incidence and associated costs were calculated for periods in and out of OAT. GEE models estimated the adjusted incidence rate ratio (IRR) for ED presentations. Average costs per person‐day were calculated with bootstrap confidence intervals. Results Incidence of urgent presentations was lower in OAT compared to out of OAT [IRR (95%CI): 0.65 (0.61‐0.69)]. In major cities, low acuity presentations were lower during OAT compared to timeout of OAT [IRR (95%CI): 0.82 (0.70‐0.96)], in regional/remote areas, low acuity presentations were higher during OAT [IRR (95%CI): 2.65 (1.66‐4.21)]. In major cities, average costs for low acuity presentations in OAT were 28% lower atA$0.50 (95%CI: A$0.48‐A$0.52) and A$0.69 (95%CI: A$0.66‐A$0.71) out of OAT, but 103% higher in regional/remote NSW, at A$2.12 (95%CI: A$1.91‐A$2.34) in OAT and A$1.04 (95%CI: A$0.91‐A$1.16) out of OAT. Discussion and Conclusions OAT was associated with reductions in urgent ED presentations and associated costs among people with OUD. Geographical variation was evident for low acuity ED presentations, highlighting the need to increase access to OAT in regional/remote areas.

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Opioid substitution therapy is associated with increased detection of hepatitis C virus infection: A 15-year observational cohort study

Cited by 11 publications

References 27 publications

Test uptake and hepatitis C prevalence in 5483 Danish people in drug use treatment from 1996 to 2015: a registry‐based cohort study

Test uptake and hepatitis C prevalence in 5483 Danish people in drug use treatment from 1996 to 2015: a registry‐based cohort study

Impact of Medication-Assisted Treatment for Opioid Addiction on Medicaid Expenditures and Health Services Utilization Rates in Vermont

Reductions in emergency department presentations associated with opioid agonist treatment vary by geographic location: A retrospective study in New South Wales, Australia

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