DISPARITIES IN HEALTH CARE EXPENDITURES AMONG US PATIENTS WITH OPIOID USE DISORDER USING BUPRENORPHINE VERSUS METHADONE
Author(s)
Sulaimon O. Abdul, BPharm, MSc, Paroma Arefin, BPharm, MPharm, Peterkings Eriuroro Jokoh, MPH, Sujit Sansgiry, MS, PhD.
Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA.
Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA.
OBJECTIVES: To evaluate disparities in health care expenditures among buprenorphine and methadone users with opioid use disorder (OUD).
METHODS: A retrospective cross-sectional analysis was conducted using 2018-2022 Medical Expenditure Panel Survey data. The cohort included adults with OUD identified using the ICD-10-CM code F11, receiving buprenorphine or methadone. Annual total and category-specific expenditures (office-based, inpatient,outpatient, prescriptions, and emergency visits) were compared using generalized linear models with a log link and gamma distribution. Models adjusted for age, sex, marital status, employment, race/ethnicity, education, poverty category, region, insurance coverage, physical limitations, affordability of care, delayed prescriptions, perceived mental and general health, delayed care, usual source of care, and social limitations.
RESULTS: The weighted cohort represented 5,689,789 OUD patients, 4,020,227 (70.66%) buprenorphine, and 1,669,562 (29.34%) methadone users. Mean total unadjusted expenditures were $17,423 overall, lower for methadone users ($10,743; SD $17,407) than buprenorphine users ($21,640; SD $49,171). Prescription spending indicated the greatest gap (methadone: $3,813; SD $8,020 vs buprenorphine: $9,613; SD $18,612). After adjustment, buprenorphine users had 225% higher total expenditures than methadone users (P<0.0001), including 34% higher office-based, 22% higher outpatient, 18% higher emergency, and ~550% higher prescription expenditures (all P<0.0001). Disparities were notable: Hispanic (30%), Non-Hispanic Black (13%), and other minority patients (38%) had lower expenditures compared to Non-Hispanic Whites. Uninsured individuals had 83% lower expenditures, while publicly insured patients had 14% higher expenditures than privately insured individuals. Physical limitations increased expenditures by 114%; low-income patients had 36% higher costs. Patients unable to afford care had 15% lower expenditures, and those without a usual source of care had markedly lower spending (>99.9%, P<0.0001).
CONCLUSIONS: Buprenorphine users incurred substantially higher expenditures than methadone users, largely driven by prescription expenditures and service-related differences. Persistent disparities by race/ethnicity, insurance, socioeconomic status, and barriers to care may suggest systemic underutilization among vulnerable OUD populations.
METHODS: A retrospective cross-sectional analysis was conducted using 2018-2022 Medical Expenditure Panel Survey data. The cohort included adults with OUD identified using the ICD-10-CM code F11, receiving buprenorphine or methadone. Annual total and category-specific expenditures (office-based, inpatient,outpatient, prescriptions, and emergency visits) were compared using generalized linear models with a log link and gamma distribution. Models adjusted for age, sex, marital status, employment, race/ethnicity, education, poverty category, region, insurance coverage, physical limitations, affordability of care, delayed prescriptions, perceived mental and general health, delayed care, usual source of care, and social limitations.
RESULTS: The weighted cohort represented 5,689,789 OUD patients, 4,020,227 (70.66%) buprenorphine, and 1,669,562 (29.34%) methadone users. Mean total unadjusted expenditures were $17,423 overall, lower for methadone users ($10,743; SD $17,407) than buprenorphine users ($21,640; SD $49,171). Prescription spending indicated the greatest gap (methadone: $3,813; SD $8,020 vs buprenorphine: $9,613; SD $18,612). After adjustment, buprenorphine users had 225% higher total expenditures than methadone users (P<0.0001), including 34% higher office-based, 22% higher outpatient, 18% higher emergency, and ~550% higher prescription expenditures (all P<0.0001). Disparities were notable: Hispanic (30%), Non-Hispanic Black (13%), and other minority patients (38%) had lower expenditures compared to Non-Hispanic Whites. Uninsured individuals had 83% lower expenditures, while publicly insured patients had 14% higher expenditures than privately insured individuals. Physical limitations increased expenditures by 114%; low-income patients had 36% higher costs. Patients unable to afford care had 15% lower expenditures, and those without a usual source of care had markedly lower spending (>99.9%, P<0.0001).
CONCLUSIONS: Buprenorphine users incurred substantially higher expenditures than methadone users, largely driven by prescription expenditures and service-related differences. Persistent disparities by race/ethnicity, insurance, socioeconomic status, and barriers to care may suggest systemic underutilization among vulnerable OUD populations.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE128
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas