Using administrative data to predict cessation risk and identify novel predictors among new entrants to opioid agonist treatment

Abstract

BackgroundLonger retention in opioid agonist treatment (OAT) is associated with improved treatment outcomes but 12-month retention rates are often low. Innovative approaches are needed to strengthen retention in OAT. We develop and compare traditional and deep learning-extensions of Cox regression to examine the potential for predicting time in OAT at individuals’ first episode entry. MethodsRetrospective cohort study in New South Wales, Australia including 16,576 people entering OAT for the first time between January 2006 and December 2017. We develop 12-month OAT cessation prediction models using traditional and deep learning-extensions of the Cox regression algorithm with predictors evaluated from linked administrative datasets. Proportion of explained variation, calibration, and discrimination are compared using 5 × 2 cross-validation. ResultsTwelve-month cessation rate was 58.4%. The largest hazard ratios for earlier cessation from the deep learning model were observed for treatment factors, including private dosing points (HR=1.54, 95% CI=1.49–1.60) and buprenorphine medication (HR=1.43, 95% CI=1.39–1.46). Diagnostic codes for homelessness (HR=1.09, 95% CI=1.04–1.13), outpatient treatment for drug use disorders (HR=1.10, 95% CI=1.06–1.15), and occupant of vehicle accident (HR=1.04, 95% CI=1.01–1.07) from past-year health service presentations were identified as significant predictors of retention. We observed no improvement in performance of the deep learning model over traditional Cox regression. ConclusionsDeep learning may be more useful in identifying novel risk factors of OAT retention from administrative data than evaluating individual-level risk. An increased focus on addressing structural issues at the population level and considering alternate models of care may be more effective at improving retention than delivering fully personalised OAT.