Tkacz JMS, Brady B, Nadipelli VR, Volpicelli J, Ronquest NA. The association between buprenorphine medication assisted treatment adherence and healthcare service utilization and costs. Poster presented at the ISPOR 21st Annual International Meeting; May 2016. Washington, DC. [abstract] Value Health. 2016 May; 19(3):A187.

OBJECTIVES: Buprenorphine medication assisted treatment (B-MAT) is an effective therapy for opioid use disorder (OUD) but may be considered cost-prohibitive based on pharmacy cost alone. This study estimated buprenorphine adherence and associated healthcare costs within a sample of OUD patients treated with B-MAT.

METHODS: Medical and pharmacy claims for members with a diagnosis of opioid dependence (ICD-9 304.0 and 304.7), abuse (305.5), or poisoning (965.0) were provided by Aetna (Blue Bell, PA) from Q1 2012 through Q1 2015. B-MAT members were identified and placed into adherent (n = 205) or non-adherent (n = 272) groups based on their one-year buprenorphine medication possession ratio (MPR of ≥ 0.80). Buprenorphine non-adherence was further examined by dividing the non-adherent group into 4 subgroups by 0.20 MPR increments. Healthcare service utilization and expenditure was measured over the 12-month period following B-MAT initiation. Service utilization and cost differences between groups were assessed via MannWhitney U tests; chi-square tests of equality of proportions were used for categorical variables. Linear contrasts were estimated with one-way analyses of variance of logged-transformed costs.

RESULTS: Compared to non-adherent members, adherent members incurred significantly greater office visits, total prescription fills, and pharmacy costs (ps < 0.01), but significantly lower outpatient hospital, ER, and inpatient visits and costs, and overall medical costs (ps < 0.05). The MPR subgroups demonstrated statistically significant linear contrasts on four cost metrics: pharmacy, outpatient hospital, inpatient hospital, and total medical (ps < 0.05). With the exception of pharmacy costs, which increased with MPR, increased adherence was associated with overall decreased healthcare costs.

CONCLUSIONS: Buprenorphine adherence is associated with increased pharmacy costs, but reduced high cost venue services and overall medical costs compared to non-adherence. The linear relationships observed in this study are evidence of a direct link between B-MAT adherence and reduced total medical expenditure.

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