Cost and utilization outcomes of opioid-dependence treatments.

OBJECTIVES: To evaluate the healthcare costs associated with treatment of opioid-dependence disorder with medications versus no medication, and with the 4 agents approved by the US Food and Drug Administration (FDA). STUDY
DESIGN: Retrospective claims database analysis.
METHODS: Eligible adults with opioid dependence were identified from a large US health plan and the PharMetrics Integrated Database. Data included all medical and pharmacy claims at all available healthcare sites. Case-mix adjustment was applied using baseline demographic, clinical, and healthcare utilization variables for 13,316 patients; half of these patients used an FDA-approved medication for opioid dependence. A similar comparison was performed among 10,513 patients treated with extended-release naltrexone (NTX-XR) (n = 156) prior to FDA approval for opioid dependence or with a medication approved at the time: oral naltrexone (NTX) (n = 845), buprenorphine (n = 7596), or methadone (n = 1916). Analyses calculated 6-month persistence, utilization, and paid claims for opioid-dependence medications, detoxification and rehabilitation, opioid-related and non-related inpatient admissions, outpatient services, and total costs.
RESULTS: Medication was associated with fewer inpatient admissions of all types. Despite higher costs for medications, total healthcare costs, including inpatient, outpatient, and pharmacy costs, were 29% lower for patients who received a medication for opioid dependence versus patients treated without medication. Patients given XR-NTX had fewer opioid-related and non-opioid-related hospitalizations than patients receiving oral medications. Despite higher costs for XR-NTX, total healthcare costs were not significantly different from those for oral NTX or buprenorphine, and were 49% lower than those for methadone.
CONCLUSION: Patients with opioid dependence who received medication for this disorder had lower hospital utilization and total costs than patients who did not receive pharmacologic therapy. Patients who received XR-NTX had lower inpatient healthcare utilization at comparable or lower total costs than those receiving oral medications.