Abstract
Buprenorphine (BUP) is commonly used in medication-assisted treatment for opioid use disorder (OUD). This study examined the association between BUP retention and healthcare resource utilization and associated costs (HCRU). A literature review was performed to examine the impact of BUP treatment retention on HCRU among patients with OUD. The PubMed database was searched (2000 – present) with keywords including “buprenorphine”, “OUD”, ”dependence”, “retention”, “adherence”, “healthcare utilization”, and “costs”. Exclusion criteria include retention/adherence as the study outcome, HCRU not as an outcome, and special populations (adolescents or prisoners). Out of a total of 234 studies, six studies were included. The Schwarz 2012 study reported data from a retrospective chart review conducted at local community centers (n=209) while the other five studies [(Manhapra 2017: veteran health administration records (n=3,151); Manhapra 2018 (n=16,190) and Ronquest 2018 (n=21,773): MarketScan claims; Tkacz 2013 (n=455) and Ruetsch 2017 (n=477): Aetna data]. Higher retention rates were found to be associated with reduced emergency department visits across all studies. Manhapra 2017 also found significant association between retention and reduction in mental health inpatient treatment, outpatient visits, and substance abuse visits. In the Tkacz study, patients adherent to BUP (medication possession ratio>=0.8) incurred $10,982 (±$4,142) for hospitalization during 12-month follow-up period, compared to $26,470 (±$3,163) for those not adherent (P<0.001). Similar correlation between higher adherence and lower healthcare utilization was also noted in the Reutsch study. However, no significant difference in hospitalization and associated costs was observed among patients demonstrating retention versus those who did not (Schwarz and Ronquest studies). This literature review showed a correlation between higher retention/adherence to BUP treatment and lower HCRU in patients with OUD. Further studies are warranted to explore cost-effectiveness of BUP retention and HCRU among patients with OUD in the real-world setting.
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