Three-Year Retention in Buprenorphine Treatment for Opioid Use Disorder Among Privately Insured Adults
Three-Year Retention in Buprenorphine Treatment for Opioid Use Disorder Among Privately Insured Adults
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DOI：
10.1176/appi.ps.201700363
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发表时间：
2018-07-01
影响因子：
3.8
通讯作者：
Rosenheck, Robert A.
中科院分区：
文献类型：
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作者：
Manhapra, Ajay;Agbese, Edeanya;Rosenheck, Robert A.
目的：本研究调查了私人保险患者中阿片类药物使用障碍 (OUD) 丁丙诺啡治疗保留的相关因素。方法：在国家私人保险索赔数据库 (MarketScan) 中确定了 2011 联邦财政年度 (FY) 期间新开始使用丁丙诺啡的 OUD 患者，并评估了 2014 财政年度的治疗保留（填写丁丙诺啡处方）。使用比例风险模型来检查人口统计、 2011 财年的临床和服务使用特征，包括与停止治疗相关的持续保险承保范围。 结果：2011 财年新开始使用丁丙诺啡的 16,190 名 OUD 患者中，45.0% 保留治疗超过一年，13.7% 保留治疗超过三年（平均 +/- SD 保留时间 = 1.23 +/- 1.16 年）。在开始使用丁丙诺啡后的前三年内，49.3% (N=7,988) 退出了保险计划。 Cox 比例风险模型显示，每入组 30 天，停药风险就会下降 10%（风险比 [HR]=.90，95% 置信区间 [CI]=. 90-.91）。 2011 财年降低停药风险的因素是年龄大于中位数 (HR=.90, CI=.87-.93) 和接受门诊心理治疗 (HR=.90, CI=.86-.92)；风险增加与精神科住院（HR=1.30，CI=1.24-1.36）、急诊科就诊（HR=1.07，CI=1.04-1.14）和其他物质使用障碍（HR=1.05，CI=1.01-1.10）有关。结论：丁丙诺啡治疗保留率在第一年显着下降，并且远低于公共资助的医疗保健系统的可比研究，显然主要是由于退学造成的。心理治疗与更大的记忆力的关联表明它可能是阿片类激动剂治疗的重要补充。
Objective: This study examined factors related to retention in buprenorphine treatment for opioid use disorder (OUD) among privately insured patients.Methods: Patients with OUD who were newly started on buprenorphine during federal fiscal year (FY) 2011 were identified in a national private insurance claims database (MarketScan), and treatment retention (filled buprenorphine prescriptions) was evaluated through FY 2014. Proportional hazards models were used to examine demographic, clinical, and service use characteristics in FY 2011, including ongoing insurance coverage, associated with discontinuation of treatment.Results: Of 16,190 patients with OUD newly started on buprenorphine in FY 2011, 45.0% were retained in treatment for more than one year, and 13.7% for more than three years (mean +/- SD duration of retention=1.23 +/- 1.16 years). During the first three years after buprenorphine initiation, 49.3% (N=7,988) disenrolled from their insurance plan. Cox proportional hazards models showed that for every 30 days of enrollment, the risk of discontinuation declined by 10% (hazard ratio [HR]=.90, 95% confidence interval [CI]=. 90-.91). FY 2011 factors reducing discontinuation risk were age greater than the median (HR=.90, CI=.87-.93) and receipt of outpatient psychotherapy (HR=.90, CI=.86-.92); increased risk was associated with psychiatric hospitalization (HR=1.30, CI=1.24-1.36), emergency department visits (HR=1.07, CI=1.04-1.14), and additional substance use disorders (HR=1.05, CI=1.01-1.10).Conclusions: Buprenorphine treatment retention declined markedly in the first year and was substantially lower than in comparable studies from publicly funded health care systems, apparently largely due to disenrollment. The association of psychotherapy with greater retention suggests that it may be an important complement to opioid agonist treatment.