Relationship between buprenorphine adherence and relapse, health care utilization and costs in privately and publicly insured patients with opioid use disorder

Naoko A Ronquest,1 Tina M Willson,2 Leslie B Montejano,2 Vijay R Nadipelli,1 Bernd A Wollschlaeger3 1Global Health Economics and Outcomes Research, Indivior Inc., Richmond, VA, USA; 2Outcomes Research, Truven Health Analytics&reg;, Part of the IBM Watson Health&trade; Business, Cambridge, MA, USA; 3Aventura Family Health Center, Miami, FL, USA Background: Treatment for opioid use disorder is important because of the negative health, societal and economic consequences of illicit opioid use, but treatment adherence can be a challenge. This study assessed the association between buprenorphine medication-assisted treatment (MAT) adherence and relapse, health care utilization and costs.Patients and methods: Patients with opioid use disorder who were newly initiating a buprenorphine MAT regimen were identified in the 2008&ndash;2014 MarketScan&reg; Commercial and Medicaid Databases and followed for 12&nbsp;months after their earliest outpatient pharmacy claim for buprenorphine. Adherence was categorized using proportion of days covered (PDC) with buprenorphine, and patients with PDC&ge;0.80 were classified as adherent. Descriptive and adjusted analyses compared relapse prevalence, utilization and costs, all measured in the 12&nbsp;months following buprenorphine MAT initiation, of adherent patients to patients in non-adherent PDC categories (PDC&lt;0.20, 0.20&le;PDC&lt;0.40, 0.40&le;PDC&lt;0.60, 0.60&le;PDC&lt;0.80).Results: Adherent patients were 37.1% of the Commercial sample (N=16,085) and 41.3% of the Medicaid sample (N=5,688). In both samples, non-adherent patients were significantly more likely than adherent patients to relapse and to have hospitalizations and emergency department visits. As a result, as buprenorphine MAT adherence increased, pharmacy costs increased, but medical costs decreased. Total costs (pharmacy plus medical costs) in the 12&nbsp;months following buprenorphine MAT initiation decreased with adherence in Commercial patients (28,525 for PDC<0.20 to 17,844 for PDC&ge;0.80). A slight decrease in total costs in the 12&nbsp;months following buprenorphine MAT initiation was also observed in Medicaid patients (21,292 for PDC<0.20 to 18,621 for PDC&ge;0.80). After adjustment, total costs of adherent patients in the Commercial sample ($17,519) were significantly lower compared with those of non-adherent patients (range$20,294&ndash;$24,431). In the Medicaid sample, adjusted total costs were not significantly different between adherence groups.Conclusion: Buprenorphine MAT adherence in the 12&nbsp;months following treatment was associated with reduced odds of relapse and reduced unadjusted medical costs. For Commercial patients who were adherent to treatment, the adjusted total costs were predicted to be 30% lower than those for patients with PDC&lt;0.20. Keywords: buprenorphine, adherence, opioid use disorder, relapse, utilization, cost

Health care costs in US patients with and without a diagnosis of osteoarthritis

T Kim Le1, Leslie B Montejano2, Zhun Cao2, Yang Zhao1, Dennis Ang31Eli Lilly and Company, Indianapolis, IN, 2Thomson Reuters, Washington, DC, 3Indiana University School of Medicine, Indianapolis, IN, USABackground: Osteoarthritis is a chronic and costly condition affecting 14% of adults in the US, and has a significant impact on patient quality of life. This retrospective cohort study compared direct health care utilization and costs between patients with osteoarthritis and a matched control group without osteoarthritis.Methods: MarketScan&amp;reg; databases were used to identify adult patients with an osteoarthritis claim (ICD-9-CM, 715.xx) in 2007, and the date of first diagnosis served as the index. Patients were excluded if they did not have 12 months of continuous health care benefit prior to and following the index date, were aged &amp;lt;18 years, or lacked a second diagnosis code for osteoarthritis between 15 and 365 days pre-index or post-index. Osteoarthritis patients were matched 1:1 to patients without osteoarthritis for age group, gender, geographic region, health plan type, and Medicare eligibility. Multivariate analyses were conducted to assess for differences in utilization and costs, controlling for differences between cohorts.Results: The study sample included 258,237 patients with osteoarthritis and 258,237 matched controls without osteoarthritis. Most patients were women and over 55 years of age. Patients with osteoarthritis had significantly higher pre-index rates of comorbidity than controls. Mean total adjusted direct costs for osteoarthritis patients were more than double those for the control group at US$18,435 (95$18,318&amp;ndash;US$18,560) versus US$7494 (95% CI: US7425&ndash;US7557). Osteoarthritis patients incurred significantly higher inpatient costs at US$6668 (95$6587&amp;ndash;US$6744) versus US$1756 (95% CI: US1717&ndash;US1794), outpatient costs at US$7840 (95$7786&amp;ndash;US$7902) versus US$3675 (95% CI: US3637&ndash;US3711), and prescription drug costs at US$3213 (95$3195&amp;ndash;US$3233) versus US$2245 (95% CI: US2229&ndash;US2262) compared with the controls.Conclusion: The direct health care costs of osteoarthritis patients were over two times higher than those of similar patients without the condition. The primary drivers of the cost difference were comorbidities and inpatient costs.Keywords: osteoarthritis, health care costs, health care utilization, comorbiditie