Abstract
Background/Aims Opioid dependence is a growing public health concern and results in high costs to individuals, health care systems, and society. Recent legislation allowing expansion of buprenorphine for replacement therapy use in general medical care settings may increase access to care for opioid dependence, but little is known about its impact on services utilization and commercial health systems costs. In this retrospective cohort study, we examined how the introduction of buprenorphine affected the pattern of medical care and addiction medicine (AM) services provided to patients with opioid dependence and associated costs.
Methods Using electronic health records, we identified individuals with two or more diagnoses of opioid dependence per year from 2000 through 2008 in two large non-profit, integrated health systems (System A: N=4,425; System B: N=7122) and assessed health system utilization and costs.
Results In both health systems and across the study period, the number of opioid-dependent persons increased considerably and the use of buprenorphine for opioid dependence treatment increased steadily. In System A, those receiving buprenorphine plus AM counseling had significantly higher costs than those receiving methadone plus AM counseling (Z= −9.22, p<.001), and significantly lower costs than those with little or no AM counseling (Z=2.81, p=.005). There were no differences in costs between those receiving buprenorphine plus AM counseling and those with AM counseling only (Z=1.30, p=.192). The treatment group by period interaction (?2 = 9.66, df=3, p=.022) was significant, with costs decreasing over time in the buprenorphine plus AM counseling group and increasing over time in all other groups. In System B, costs were significantly lower for the buprenorphine plus AM counseling group than for the group with little or no AM counseling (Z= −5.14, p<.001) and higher than for the group with AM counseling only (Z=5.56, p=.001). The treatment group by period interaction was not significant (?2 =1.23, df=2, p=.540).
Discussion Buprenorphine treatment is emerging as a viable alternative to other AM treatment approaches for persons with opioid dependence. Results of this study provide further evidence that buprenorphine treatment can be provided at a similar cost to alternative strategies in private integrated health systems.
