Cost and utilization outcomes of opioid-dependence treatments

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).

Retrospective claims database analysis.

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.

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.

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.