Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder: A Cohort Study.
Relative Cost Differences of Initial Treatment Strategies for Newly Diagnosed Opioid Use Disorder: A Cohort Study.
复制标题
DOI：
10.1097/mlr.0000000000001394
复制
发表时间：
2020-10
期刊：
影响因子：
3
通讯作者：
Sanghavi DM
中科院分区：
文献类型：
--
作者：
Larochelle MR;Wakeman SE;Ameli O;Chaisson CE;McPheeters JT;Crown WH;Azocar F;Sanghavi DM
补充数字内容可在文本中找到。阿片类药物使用障碍（OUD）治疗方案之间的相对护理成本尚不清楚。我们在一个大型的国家去识别索赔数据库中确定了一个新诊断为OUD的40，885人的队列，该数据库涵盖商业保险和Medicare Advantage登记者。我们将个体分配到6个相互排斥的初始治疗途径中的一个：（1）住院排毒/康复治疗中心;（2）行为健康强化，强化门诊或部分住院服务;（3）美沙酮或丁丙诺啡;（4）纳洛酮;（5）行为健康门诊服务，或;（6）不治疗。我们使用控制基线成本的差异方法评估了每种策略在最初90天治疗期的总护理成本。在诊断后90天内，94.8%的人接受了治疗，最初的治疗是：15.8%接受住院排毒/康复治疗中心，4.8%接受行为健康强化，强化门诊或部分住院服务，12.5%接受丁丙诺啡/美沙酮，2.4%接受纳洛酮，59.3%接受行为健康门诊服务。平均未调整成本从基线时的每月3250美元（SD $7846）增加到90天随访期内的每月5047美元（SD $11，856）。与未治疗相比，丁丙诺啡/美沙酮[调整差异成本比（ADIDCR）0.65; 95%置信区间（CI），0.52-0.80]、纳洛酮（ADIDCR 0.53; 95% CI，0.42-0.67）和行为健康门诊（ADIDCR 0.54; 95% CI，0.44-0.66）的初始90天成本较低。住院戒毒费用较高（ADIDCR 2.30; 95% CI，1.88-2.83）。提高卫生系统的能力和保险覆盖面，并鼓励门诊管理的OUD可能会降低医疗保健费用。
Supplemental Digital Content is available in the text. Relative costs of care among treatment options for opioid use disorder (OUD) are unknown. 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. 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). Improving health system capacity and insurance coverage and incentives for outpatient management of OUD may reduce health care costs.