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Clinical and Cost Outcomes of Buprenorphine Treatment in a Commercial Benefit Plan Population

Buprenorphine treatment with and without induction was found to decrease costs and utilization in opioid-dependent benefciaries.
Published Online: Feb 02,2018
Julie B. Kessel, MD; Liana D. Castel, PhD; and Douglas A. Nemecek, MD
Eighty-eight customers were found to have the H0033 procedure on a claim. Twenty-three records were excluded because there were no corresponding pharmacy claims for buprenorphine; they were either ineligible for the benefit plan’s pharmacy (n = 8), their medical benefits enrollment was interrupted, or they resided in California, where providers submit encounter-only, rather than actual claims, data to Cigna (n = 9).

Service codes on the induction group’s outpatient claims indicated group, individual, and family therapy; nonspecific office visits (such as outpatient); and programmatic intensive outpatient level of care. Claims submitted were assigned to 1 of 3 benefit categories: detoxification, chemical dependence, and non-substance-related mental health. In order to match groups for claims submitted, only claims for these types of services were considered in the analysis for the noninduction group and the no-treatment group. This reduced the number of records included in the analytic sample by 61.7% in the noninduction group and by 94.9% in the no-treatment group.

Of the 8503 opioid-dependent individuals initially identified, 648 met the final criteria for study inclusion. The final study group consisted of 48 undergoing induction treatment, 241 undergoing noninduction, and 359 in the no-treatment group.

The 4-month baseline and follow-up periods were based on the date of the earliest H0033 procedure for the induction group (index date) and on the earliest opioid-related outpatient visit for the noninduction and no-treatment groups.

Mean age, gender, age, and number of unique baseline diagnoses were compared across groups. Baseline diagnoses were stratified into only nonpsychotropic (not including buprenorphine) prescriptions and psychotropic prescriptions.

Clinical outcomes included changes in the rates of medical and behavioral health hospitalizations and in inpatient detoxification services from the baseline to the follow-up period. Four-month baseline and follow-up costs and services for medical and behavioral health outpatient, inpatient, nonpsychotropic, and psychotropic pharmacy were calculated and reported as per-customer/member per-month or utilization-per-1000 respectively. Claims with zero cost amounts were kept, but to mitigate the effects of outliers, total costs were capped at $50,000 (corresponding with a “catastrophic spend”) based on the full 4 months of each period.

Statistical Analyses
Homogeneity tests between groups were conducted using χ2 tests. Student’s t tests, χ2 distributions, and analyses of variance were used to compare demographics and clinical outcomes on the average number of diagnoses between and across groups.

Percent change from the index period to the postindex period for inpatient detoxification and medical or behavioral health hospitalization (inpatient levels of care for psychiatric illness or substance abuse, other than detoxification units) was compared using a test for difference in proportions, with alpha = 0.05. Primary, secondary, or tertiary International Classification of Diseases, Ninth Revision, Clinical Modification codes included 337.0-337.9, 338.4, 339.00-339.89, 346.00-346.93, 350.1, 353, 354.1-354.9, 355.0-355.9, 356.0-356.9, 357.1-357.7, 531.3, 617.0-617.9, 625.5, 696, 710, 711.8, 714.0-714.33, 715.00-715.09, 715.3-715.9, 720.0-720.9, 721.0-721.90, 723.4, and 725-729.99.

Difference in differences analysis among groups was used to examine the change in total healthcare costs and utilization from baseline to the 4-month follow-up. General linear regression was used to compare adjusted cost ratios. Unadjusted ratios and actual costs were also reported. Although most outcomes were adjusted for age, gender, the interaction between age and gender, and type of benefit plan, inpatient cost and utilization outcomes were unadjusted due to scarce follow-up volume of service.