Costs of Care for Persons with Opioid Dependence

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Costs of Care for Persons with Opioid Dependence In Two Integrated Health Systems

Frances Lynch, PhD
April 30, 2012
HMO Research Network Conference 2012

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Costs of Care for Persons with Opioid Dependence

  1. 1. Costs of Care for Persons with Opioid Dependence In Two Integrated Health Systems Frances Lynch, PhD April 30, 2012 HMORN Research Conference Seattle, WA© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  2. 2. Co-Authors Dennis McCarty, PhD (Principal Investigator) Jennifer Mertens, PhD Nancy Perrin, PhD Carla A. Green, PhD Sujaya Parasarathy, PhD Bradley Anderson, MD David Pating, MD We gratefully acknowledge funding from the National Institute on Drug Abuse, (R01 DA016341)© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  3. 3. BACKGROUND© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  4. 4. Opioid Dependence  Opioid dependence – inability to stop using opioids (e.g., heroin, oxycodone) even with significant negative consequences  Prevalence is difficult to determine accurately  Common estimate 600,000 opioid addicts & 2 million abusers  Dependence on prescription pain relievers is growing –  20% increase between 2004 and 2009 (NSUDH 2009)  Youth, older adults, and women, may be at particular risk  Opioid abuse and dependence has high costs to individuals, health care systems, and society© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  5. 5. Opioid Dependence in private health systems  In past, private health care systems have been reluctant to treat opioid dependence  Concerns about attracting high risk populations  Treatments difficult to administer well  Changes in patterns opioid use and health insurance are changing private systems interest in treating opioid dependence  Issues for private health systems include:  Costs of providing opioid dependence treatment  Costs of managing affects of opioid use on member’s health  Avoiding misuse of opioid drugs  Maintaining appropriate management of chronic pain© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  6. 6. Treatment of Opioid Dependence  Methadone  Addiction Medicine Counseling  Group  Individual  Buprenorphine  Other Medications© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  7. 7. Buprenorphine  Drug Abuse Treatment Act of 2000  Authorized waivers for qualified physicians  Caseload = 30 or less patients per group (i.e., a health plan)  FDA approved October 2002  DATA 2000 amended: caseload =30 or less patients per physician (December 2005)  DATA 2000 amended: caseload =100 or less patients per physician (January 2007)© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  8. 8. Motivation for studying opioid dependence in private health systems  Most health plans have little experience with opioid agonist treatment  Growing interest in agonist therapy  Growing private health system population with opioid dx  Effectiveness and ease of use of buprenorphine  Some research suggests buprenorphine is more costly than methadone  Health systems need information about relative costs of treatment options in real world health care settings© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  9. 9. Study Objectives:  Describe health care and addiction medicine services for persons with opioid dependence in two integrated health systems  Examine health system costs for persons with opioid dependence and assess the impact of buprenorphine on those costs© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  10. 10. DESCRIPTION OF STUDY: Adoption of Buprenorphine in Two Private Not-for-Profit Integrated Health Systems© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  11. 11. Methods: Study Design Retrospective cohort with data from 2 not-for-profit health systems Included all persons with  2 or more diagnoses of opioid dependence in a given year  Between 2000 and 2008 Classified patients into four groups:  methadone plus counseling,  buprenorphine (but no methadone) plus counseling,  two or more counseling sessions (and no medication)  one or fewer counseling sessions (and no medication)© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  12. 12. Statistical Analyses  Descriptive analysis of trends over time in opioid dx and treatment modalities  GEE models to examine pattern of total health plan costs and types of service use over time by treatment group  Used propensity scores to help control for differences in patient characteristics related to treatment group© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  13. 13. Figure 1. Trends Over Time in Opioid Diagnoses and Treatments Health Plan A© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  14. 14. RESULTS© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  15. 15. Figure 2. Trends Over Time in Opioid Diagnoses and Treatment Health Plan B© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  16. 16. Table 1: Description of Sample Health System A Health System B N= 4425 N=7122Age (mean, sd) 41(14) 43 (13)Gender (% female) 50% 53% N for Implementation PeriodLittle or no AM 30 pt/MD =379 30 pt/MD =977counseling 100 pt/MD =531 100 pt/MD =1301AM Counseling Only 30 pt/MD =389 30 pt/MD =1722 100 pt/MD =508 100 pt/MD =1781Buprenorphine plus 30 pt/MD =379 30 pt/MD =219AM counseling 100 pt/MD =835 100 pt/MD =1122Methadone plus AM 30 pt/MD =692 N/Acounseling 100 pt/MD=797
  17. 17. Table 2: Adjusted Mean Annual Cost by Time Period (2008 $) Implementation Health System A Health System B Period 16,894 15,434 30 pt/MDAM Counseling (14,399-19390) (14,180-18,610)Only 18,617 17,445 100 pt/MD (15,401-21,833) (16,280-18,610) 26,046 21183 30 pt/MDLittle or no AM (21,252-30,840) (18662-23703)counseling 26,292 22041 100 pt/MD (22,522-30,062) (19374-24707) 16,230 17240Buprenorphine 30 pt/MD (14,352-18,107) (15326-19515)Plus AMCounseling 17,921 18150 100 pt/MD (16,131-19,711) (16589-19711) 10,789 30 pt/MDMethadone Plus (7310-14,267) N/AAM Counseling 12,379 100 pt/MD (10,201-14,558)
  18. 18. Table 3: Health Care Service Use Means (SD) Health System A Implementation Inpatient AM PC ER MH Other Period Detox Residential visits visits visits visits StaysAM Counseling .18 .18 5.10 1.12 3.17 4.24 30 pt/MDOnly (.14) (.14) (.06) (.14) (.16) (.08) 0.17 .15 5.11 0.95 3.46 3.82 100 pt/MD (.14) (.16) (.05) (.12) (.14) (.08)Little or no AM .03 .01 4.90 1.40 2.25 4.37 30 pt/MDcounseling (.35) (.59) (.06) (.14) (.18) (.11) .01 .01 5.09 0.92 3.64 4.74 100 pt/MD (.44) (.61) (.06) (.14) (.21) (.12)Buprenorphine .46 .13 4.06 0.88 1.67 3.09 30 pt/MDPlus AM (.09) (.15) (.05) (.13) (.19) (.09)Counseling .27 .11 3.86 0.66 2.03 3.02 100 pt/MD (.10) (.15) (.06) (.13) (.15) (.08)Methadone Plus .02 .01 3.30 0.66 0.82 2.415 30 pt/MDAM counseling (.29) (.37) (.06) (.14) (.18) (.10) .03 .02 3.59 0.50 1.04 2.94 100 pt/MD (.33) (.33) (.06) (.14) (.16) (.09)
  19. 19. Table 3: Health Care Service Use Means (SD) Health System B Implementation Inpatient AM PC ER MH Other Period Detox Residential visits visits visits visits StaysAM Counseling Only .02 .05 5.60 1.47 3.06 8.09 30 pt/MD (.19) (.13) (.03) (.06) (.08) (.04) 0.03 .05 5.87 1.59 3.59 7.25 100 pt/MD (.15) (.13) (.02) (.05) (.09) (.04)Little or no AM .01 .00 7.10 1.69 2.97 6.74counseling 30 pt/MD (.43) (.61) (.03) (.06) (.10) (.05) .01 .01 6.57 1.76 3.31 7.12 100 pt/MD (.44) (.44) (.03) (.06) (.12) (.05)Buprenorphine Plus AM .05 .10 4.82 1.44 1.89 10.15Counseling 30 pt/MD (.31) (.23) (.07) (.13) (.17) (.14) .03 .06 5.41 1.39 2.85 6.71 100 pt/MD (.28) (.16) (.03) (.08) (.11) (.05)
  20. 20. Limitations  Retrospective cohort design, no randomization to treatment  Treatment group selection likely.  No detailed information on drug use history  Study in Western United States, may not generalize to other areas© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  21. 21. Summary and discussion  Buprenorphine successfully provided for persons with opioid dependence in two integrated health systems  Buprenrorphine patients had higher total costs compared to methadone patients  Buprenorphine patients had similar total costs to patients receiving counseling  Buprenorphine patients had lower total costs compared to patients with little or no treatment© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  22. 22. Importance of health system infrastructure to support buprenorphine-assisted treatment  Health plan A implemented more quickly  Smaller system – only to two sites offering Buprenorphine, with one chief of both  Staff had prior experience using buprenorphine from a clinical trial  Health plan B implemented more slowly  Substantially larger system - over 20 clinics treating opioid dependence  Each clinic had separate chief and each clinic developed its own procedures© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH
  23. 23. Preliminary Conclusions  Buprenorphine can be successfully offered in integrated health systems to privately insured patients  Total health system costs of buprenorphine are similar to total costs for patients in abstinence-based counseling© 2011, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH

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