OBJECTIVES

Opioid Use Disorder (OUD) is a chronic brain disease that can be successfully managed with buprenorphine (BPN). Like other chronic diseases, OUD involves cycles of relapse and remission, with relapse often associated with medication treatment discontinuation. This study seeks to characterize the relationship between healthcare expenditures and OUD patient relapse and to evaluate real-world BPN treatment persistence.

METHODS

This retrospective observational study of patients with OUD enrolled in commercial, Medicare and Medicaid plans included claims data incurred between 01/01/2011 and 03/31/2018. Patients were required to have a minimum of two years of follow up and were split into three cohorts: OUD with relapse, OUD without relapse, and control (treated with acute opioids). A 1:1:1 propensity score match was performed.

RESULTS

3,630 propensity matched patients from each of the cohorts qualified for the analysis with 71% enrolled in a Medicaid plan. Highest rates of anxiety, bipolar disorder, depression, and hepatitis C were found for OUD patients with relapse. OUD patients with relapse also incurred greater per member medical costs ($28,944) as compared to OUD patients without relapse ($18,252), and control ($11,880) (p=0.0203). Among patients with OUD, costs related to opioid dependence were higher for the relapsing cohort ($10,383) as compared to the non-relapsing cohort ($3,550) (p=0.0203). OUD patients demonstrated low persistence in buprenorphine treatment for both the relapsing (125 mean days in treatment episode) and non-relapsing (173 days) cohorts.

CONCLUSIONS

In patients with OUD, relapse (as compared to no relapse) was associated with an increase in medical utilization that resulted in greater annual medical spend. Improved methods to identify patients with OUD in need of additional interventions and methods to prolong medication treatment duration are needed.