Methadone maintenance and the cost and utilization of health care among individuals dependent on opioids in a commercial health plan.
BACKGROUND
Few health plans provide maintenance medication for opioid dependence. This study assessed the cost of treating opioid-dependent members in a commercial health plan and the impacts of methadone maintenance on costs of care.


METHODS
Individuals with diagnoses of opioid dependence (two or more diagnoses per year) and at least 9 months of health plan eligibility each year were extracted from electronic health records for the years 2000 through 2004 (1,518 individuals and 2,523 observations across the study period-some individuals were in multiple years). Analyses examined the patterns and costs of health care for three groups of patients: (1) one or more methadone visits during the year (n=1,298; 51%); (2) no methadone visits and 0 or 1 visits in the Addiction Medicine Department (n=370; 15%); (3) no methadone visits and 2 or more visits in addiction medicine (n=855; 34%).


RESULTS
Primary care (86%), emergency department (48%) and inpatient (24%) visits were common. Mean total annual costs to the health plan were $11,200 (2004 dollars) per member per year. The health plan's costs for members receiving methadone maintenance were 50% lower ($7,163) when compared to those with two or more outpatient addiction treatment visits but no methadone ($14,157) and 62% lower than those with one or zero outpatient addiction treatment visits and no methadone treatment ($18,694).


CONCLUSIONS
Use of opioid maintenance services was associated with lower total costs of care for opioid-dependent members in a commercial health plan.
McCarty
Dennis
D
Oregon Health & Science University, Portland, OR 97239, USA. mccartyd@ohsu.edu
Perrin
Nancy A
NA
Green
Carla A
CA
Polen
Michael R
MR
Leo
Michael C
MC
Lynch
Frances
F
D000328:Adult; D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000191:economics* / Q000706:statistics & numerical data; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000191:economics*; D017061:Prepaid Health Plans / Q000191:economics* / Q000706:statistics & numerical data
D008691:Methadone