Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder

Larochelle, Marc R.; Wakeman, Sarah E.; Ameli, Omid; Chaisson, Christine E.; McPheeters, Jeffrey; Crown, William H.; Azocar, Francisca; Sanghavi, Darshak M.

doi:10.1097/mlr.0000000000001394

Cited by 9 publications

(9 citation statements)

References 35 publications

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“…10,28 Notably, detoxification and inpatient treatment, common points of initial treatment-seeking for individuals with OUD, are expensive, and associated costs may deter seeking outpatient follow-up. 29,30 While these services are important for some individuals, it is possible to initiate MOUD in an outpatient setting first. Delivery systems and benefit designs should be redesigned to promote low-threshold MOUD initiation and uptake.…”

Section: Discussionmentioning

confidence: 99%

Variation in Initiation, Engagement, and Retention on Medications for Opioid Use Disorder Based on Health Insurance Plan Design

et al. 2022

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Background: The association between cost-sharing and receipt of medication for opioid use disorder (MOUD) is unknown.Methods: We constructed a cohort of 10,513 commercially insured individuals with a new diagnosis of opioid use disorder and information on insurance cost-sharing in a large national deidentified claims database. We examined 4 cost-sharing measures: (1) pharmacy deductible; (2) medical service deductible; (3) pharmacy medication copay; and (4) medical office copay. We measured MOUD (naltrexone, buprenorphine, or methadone) initiation (within 14 d of diagnosis), engagement (second receipt within 34 d of first), and 6-month retention (continuous receipt without 14-d gap). We used multivariable logistic regression to assess the association between cost-sharing and MOUD initiation, engagement, and retention. We calculated total out-of-pocket costs in the 30 days following MOUD initiation for each type of MOUD.Results: Of 10,513 individuals with incident opioid use disorder, 1202 (11%) initiated MOUD, 742 (7%) engaged, and 253 (2%) were

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Section: Discussionmentioning

confidence: 99%

Variation in Initiation, Engagement, and Retention on Medications for Opioid Use Disorder Based on Health Insurance Plan Design

et al. 2022

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“…We then captured total, in-person, and telemedicine OUD visits within 90 days of an index visit. For MOUD prescribing, consistent with a previous study, 7 we defined 2 measures of MOUD initiation: (1) the proportion of patients with OUD with initiation within 90 days of the index visit, and (2) the proportion of patients with OUD with initiation within 14 days of the index visit. Retention of MOUD was defined as at least 1 additional MOUD fill within 30 to 90 days of initiation among those with initiation within 14 days of the index visit.…”

Section: Study Outcomesmentioning

confidence: 99%

“…Medications for opioid use disorder (MOUD), which include methadone, buprenorphine, and longacting injectable naltrexone, are considered the most effective treatments available for OUD. [3][4][5][6][7][8][9][10] However, in 2019, the National Survey on Drug Use and Health found that just 27.8% of individuals who needed OUD treatment received MOUD. 11 For decades, there have been long-standing barriers to OUD care, including clinician shortages, stigma, cost, and transportation challenges.…”

Section: Introductionmentioning

confidence: 99%

“…However, access to OUD treatment has remained limited. Medications for opioid use disorder (MOUD), which include methadone, buprenorphine, and long-acting injectable naltrexone, are considered the most effective treatments available for OUD . However, in 2019, the National Survey on Drug Use and Health found that just 27.8% of individuals who needed OUD treatment received MOUD .…”

Section: Introductionmentioning

confidence: 99%

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Telemedicine Use and Quality of Opioid Use Disorder Treatment in the US During the COVID-19 Pandemic

et al. 2023

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ImportanceLittle is known about the potential implications of the rapid transition to telehealth during the COVID-19 pandemic for treatment of opioid use disorder (OUD).ObjectiveTo examine the association between telemedicine adoption during the COVID-19 pandemic and indicators of OUD treatment quality.Design, Setting, and ParticipantsThis cohort study analyzed deidentified administrative claims data from OptumLabs Data Warehouse. Claims for telemedicine visits were included for both the prepandemic period (March 14, 2019, to March 13, 2020) and pandemic period (March 14, 2020, to March 13, 2021). Patients with OUD and continuous enrollment in either commercial insurance or Medicare Advantage plans were included. Clinicians who provided office-based OUD care were included and categorized into low, medium, or high telemedicine use groups. Patients were attributed to the clinician (and corresponding telemedicine use group) from whom they received a plurality of OUD visits.Main Outcomes and MeasuresThe 4 outcomes were all outpatient visits, OUD visits (in person vs telemedicine) within 90 days of an index visit, medications for OUD (MOUD) prescribing, and OUD-related clinical events (including drug overdose, inpatient detoxification and rehabilitation center stay, or injection drug use–related infections).ResultsThe analysis included 11 801 patients (mean [SD] age, 53.9 [15.7] years; 5902 males [50.0%]) who were treated by 1768 clinicians. Clinicians with low vs high telemedicine use conducted a mean (SD) of 2.1% (2.5%) vs 69.5% (18.6%) of their office visits virtually in the pandemic period. While telemedicine use for OUD increased significantly from the prepandemic to pandemic periods, total OUD visit volume (in person plus telemedicine) per patient episode remained stable among both high (2.6 to 2.7 visits per patient episode) and low (3.1 to 3.3 visits per patient episode) telemedicine use groups. In adjusted analyses comparing the prepandemic with pandemic periods, there was no differential change in MOUD initiation (adjusted odds ratio [OR], 1.00; 95% CI, 0.84-1.19), MOUD days’ supply (differential change in days’ supply, –0.27; 95% CI, –1.84 to 1.30), or OUD-related clinical events (adjusted OR, 1.01; 95% CI, 0.73-1.24) among patients who were treated by clinicians in low vs high telemedicine use groups.Conclusions and RelevanceResults of this study revealed that clinical outcomes were similar among patients who were treated by clinicians with high and low telemedicine use during the COVID-19 pandemic, suggesting that telemedicine is a comparable alternative to in-person OUD care. There was no evidence that telemedicine was associated with increased access to or improved quality of OUD treatment.

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“…In the United States, approximately $1.02 trillion was spent on opioid use disorders and fatal opioid overdoses in 2017 (4). Incidence of fatal opioid overdose continue to surge in the United States (5). In China, about 1.8 million people use illicit drugs, of which 734,000 are opioid abusers, accounting for 40.8% of it (6).…”

Section: Introductionmentioning

confidence: 99%

Clinical and Economic Evaluation of Acupuncture for Opioid-Dependent Patients Receiving Methadone Maintenance Treatment: The Integrative Clinical Trial and Evidence-Based Data

Wen

Wei

et al. 2021

Front. Public Health

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Objective: From the health care and societal perspectives, this study aimed to evaluate the clinical and economic effects of acupuncture as an adjunctive therapy for patients receiving methadone maintenance treatment (MMT).Methods: We conducted a parallel-arm RCT in China in 2019. Patients were included who met the diagnostic criteria and receive MMT for more than 30 days. Patients were randomly assigned to the exposed group (acupuncture plus MMT) or control group (MMT) at a 1:1 ratio. Daily methadone dosage, drug cravings using the VAS score, and insomnia using the Pittsburgh Sleep Quality Index (PSQI) were chosen as the effectiveness indexes, and the quality-adjusted life years (QALYs) was chosen as the utility index.Results: Overall, 123 patients were included. The exposed group was significantly (P < 0.05) better than the control group in the improvement of daily methadone dosage (17.68 vs. 1.07), VAS (38.27 vs. 2.64), and PSQI (2.18 vs. 0.30). The QALY was 0.0784 (95%CI: 0.0761–0.0808) for the exposed group and 0.0762 (95%CI: 0.0738–0.0787) for the control group. The total cost of the exposed group (2869.50 CNY) was higher than the control group (2186.04 CNY). The ICER of daily methadone dosage (41.15), VAS (17.86), and PSQI (313.51) were shown to be economically efficient. While ICUR (310,663.64 CNY/QYLY) was higher than the cost suggested by WHO.Conclusion: Acupuncture as an adjuvant therapy for MMT patients realizes its cost-effectiveness by reducing the dosage of methadone, improving drug cravings, and alleviating insomnia. It helps to improve quality of life, but since its cost exceeds what society is willing to pay, further study is needed.

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Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder

Abstract: Supplemental Digital Content is available in the text.

Cited by 9 publications

References 35 publications

Variation in Initiation, Engagement, and Retention on Medications for Opioid Use Disorder Based on Health Insurance Plan Design

Variation in Initiation, Engagement, and Retention on Medications for Opioid Use Disorder Based on Health Insurance Plan Design

Telemedicine Use and Quality of Opioid Use Disorder Treatment in the US During the COVID-19 Pandemic

Clinical and Economic Evaluation of Acupuncture for Opioid-Dependent Patients Receiving Methadone Maintenance Treatment: The Integrative Clinical Trial and Evidence-Based Data

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