دورية أكاديمية
Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder: A Cohort Study.
| العنوان: | Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder: A Cohort Study. |
|---|---|
| المؤلفون: | Larochelle MR; Clinical Addiction Research and Education Unit at Boston University School of Medicine and Boston Medical Center., Wakeman SE; Massachusetts General Hospital, Division of General Internal Medicine and Harvard Medical School, Boston., Ameli O; OptumLabs, Cambridge, MA., Chaisson CE; OptumLabs, Cambridge, MA., McPheeters JT; OptumLabs., Crown WH; OptumLabs, Cambridge, MA., Azocar F; Optum Behavioral Health, Eden Prairie., Sanghavi DM; UnitedHealthcare, Minnesota, MN. |
| المصدر: | Medical care [Med Care] 2020 Oct; Vol. 58 (10), pp. 919-926. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0230027 Publication Model: Print Cited Medium: Internet ISSN: 1537-1948 (Electronic) Linking ISSN: 00257079 NLM ISO Abbreviation: Med Care Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Hagerstown, MD : Lippincott Williams & Wilkins Original Publication: Philadelphia, etc., Lippincott. |
| مواضيع طبية MeSH: | Opiate Substitution Treatment/*economics , Opioid-Related Disorders/*drug therapy , Opioid-Related Disorders/*economics , Opioid-Related Disorders/*rehabilitation, Adolescent ; Adult ; Aged ; Ambulatory Care/economics ; Behavior Therapy/economics ; Buprenorphine/therapeutic use ; Cohort Studies ; Female ; Health Care Costs ; Hospitalization/economics ; Humans ; Male ; Medicare ; Methadone/therapeutic use ; Middle Aged ; Naltrexone/therapeutic use ; Narcotic Antagonists/therapeutic use ; Retrospective Studies ; United States |
| مستخلص: | 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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| معلومات مُعتمدة: | U24 AA020779 United States AA NIAAA NIH HHS; UM1 DA049412 United States DA NIDA NIH HHS; U01 NS086659 United States NS NINDS NIH HHS; U01 NS093334 United States NS NINDS NIH HHS; U01 AA020776 United States AA NIAAA NIH HHS; R01 AA021335 United States AA NIAAA NIH HHS; K23 DA042168 United States DA NIDA NIH HHS; R01 DA044526 United States DA NIDA NIH HHS; P50 DC013027 United States DC NIDCD NIH HHS; UL1 TR001430 United States TR NCATS NIH HHS; U01 AA021989 United States AA NIAAA NIH HHS; HHSF223200910006I United States FD FDA HHS; R01 DA032082 United States DA NIDA NIH HHS; P30 AG013846 United States AG NIA NIH HHS; U01 CE002780 United States CE NCIPC CDC HHS; UG1 DA015831 United States DA NIDA NIH HHS; R01 DA037768 United States DA NIDA NIH HHS; U24 MD006964 United States MD NIMHD NIH HHS; R01 AR055557 United States AR NIAMS NIH HHS |
| المشرفين على المادة: | 0 (Narcotic Antagonists) 40D3SCR4GZ (Buprenorphine) 5S6W795CQM (Naltrexone) UC6VBE7V1Z (Methadone) |
| تواريخ الأحداث: | Date Created: 20200826 Date Completed: 20201102 Latest Revision: 20240803 |
| رمز التحديث: | 20240803 |
| مُعرف محوري في PubMed: | PMC7641182 |
| DOI: | 10.1097/MLR.0000000000001394 |
| PMID: | 32842044 |
| قاعدة البيانات: | MEDLINE |
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