title: Costs of care for persons with opioid dependence in commercial integrated health systems.
abstract: BACKGROUND
  When used in general medical practices, buprenorphine is an effective treatment for opioid dependence, yet little is known about how use of buprenorphine affects the utilization and cost of health care in commercial health systems.
  
  
  METHODS
  The objective of this retrospective cohort study was to examine how buprenorphine affects patterns of medical care, addiction medicine services, and costs from the health system perspective. Individuals with two or more opioid-dependence diagnoses per year, in two large health systems (System A: n = 1836; System B: n = 4204) over the time span 2007-2008 were included. Propensity scores were used to help adjust for group differences.
  
  
  RESULTS
  Patients receiving buprenorphine plus addiction counseling had significantly lower total health care costs than patients with little or no addiction treatment (mean health care costs with buprenorphine treatment = $13,578; vs. mean health care costs with no addiction treatment = $31,055; p < .0001), while those receiving buprenorphine plus addiction counseling and those with addiction counseling only did not differ significantly in total health care costs (mean costs with counseling only: $17,017; p = .5897). In comparison to patients receiving buprenorphine plus counseling, those with little or no addiction treatment had significantly greater use of primary care (p < .001), other medical visits (p = .001), and emergency services (p = .020). Patients with counseling only (compared to patients with buprenorphine plus counseling) used less inpatient detoxification (p < .001), and had significantly more PC visits (p = .001), other medical visits (p = .005), and mental health visits (p = .002).
  
  
  CONCLUSIONS
  Buprenorphine is a viable alternative to other treatment approaches for opioid dependence in commercial integrated health systems, with total costs of health care similar to abstinence-based counseling. Patients with buprenorphine plus counseling had reduced use of general medical services compared to the alternatives.
authors.affiliation: Kaiser Permanente Center for Health Research, 3800 N, Interstate Avenue, Portland, OR 97227, USA. frances.lynch@kpchr.org.
authors.forename: Frances L
authors.initials: FL
authors.lastname: Lynch
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mertens
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Perrin
authors.forename: Carla A
authors.initials: CA
authors.lastname: Green
authors.forename: Sujaya
authors.initials: S
authors.lastname: Parthasarathy
authors.forename: John F
authors.initials: JF
authors.lastname: Dickerson
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Anderson
authors.forename: David
authors.initials: D
authors.lastname: Pating
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000191:economics*; D003132:Commerce / Q000191:economics*; D017281:Cost of Illness; D003376:Counseling / Q000191:economics; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000191:economics* / Q000534:rehabilitation*; D012189:Retrospective Studies; D014481:United States; D014600:Utilization Review
chemical_list: D002047:Buprenorphine