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

Authors
  • Larochelle, Marc R.1
  • Wakeman, Sarah E.2
  • Ameli, Omid3
  • Chaisson, Christine E.3
  • McPheeters, Jeffrey T.4
  • Crown, William H.3
  • Azocar, Francisca5
  • Sanghavi, Darshak M.6
  • 1 Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center
  • 2 Massachusetts General Hospital, Division of General Internal Medicine and Harvard Medical School, Boston
  • 3 OptumLabs, Cambridge, MA
  • 4 OptumLabs
  • 5 Optum Behavioral Health, Eden Prairie
  • 6 UnitedHealthcare, Minnesota, MN
Type
Published Article
Journal
Medical Care
Publisher
Lippincott Williams & Wilkins
Publication Date
Aug 24, 2020
Volume
58
Issue
10
Pages
919–926
Identifiers
DOI: 10.1097/MLR.0000000000001394
PMID: 32842044
PMCID: PMC7641182
Source
PubMed Central
Keywords
License
Green

Abstract

Background: Relative costs of care among treatment options for opioid use disorder (OUD) are unknown. Methods: We identified a cohort of 40,885 individuals with a new diagnosis of OUD in a large national de-identified claims database covering commercially insured and Medicare Advantage enrollees. We assigned individuals to 1 of 6 mutually exclusive initial treatment pathways: (1) Inpatient Detox/Rehabilitation Treatment Center; (2) Behavioral Health Intensive, intensive outpatient or Partial Hospitalization Services; (3) Methadone or Buprenorphine; (4) Naltrexone; (5) Behavioral Health Outpatient Services, or; (6) No Treatment. We assessed total costs of care in the initial 90 day treatment period for each strategy using a differences in differences approach controlling for baseline costs. Results: Within 90 days of diagnosis, 94.8% of individuals received treatment, with the initial treatments being: 15.8% for Inpatient Detox/Rehabilitation Treatment Center, 4.8% for Behavioral Health Intensive, Intensive Outpatient or Partial Hospitalization Services, 12.5% for buprenorphine/methadone, 2.4% for naltrexone, and 59.3% for Behavioral Health Outpatient Services. Average unadjusted costs increased from $3250 per member per month (SD $7846) at baseline to $5047 per member per month (SD $11,856) in the 90 day follow-up period. Compared with no treatment, initial 90 day costs were lower for buprenorphine/methadone [Adjusted Difference in Differences Cost Ratio (ADIDCR) 0.65; 95% confidence interval (CI), 0.52–0.80], naltrexone (ADIDCR 0.53; 95% CI, 0.42–0.67), and behavioral health outpatient (ADIDCR 0.54; 95% CI, 0.44–0.66). Costs were higher for inpatient detox (ADIDCR 2.30; 95% CI, 1.88–2.83). Conclusion: Improving health system capacity and insurance coverage and incentives for outpatient management of OUD may reduce health care costs.

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