title: Risk Factors for Relapse and Higher Costs Among Medicaid Members with Opioid Dependence or Abuse: Opioid Agonists, Comorbidities, and Treatment History.
abstract: Clinical trials show that opioid agonist therapy (OAT) with methadone or buprenorphine is more effective than behavioral treatments, but state policymakers remain ambivalent about covering OAT for long periods. We used Medicaid claims for 52,278 Massachusetts Medicaid beneficiaries with a diagnosis of opioid abuse or dependence between 2004 and 2010 to study associations between use of methadone, buprenorphine or other behavioral health treatment without OAT, and time to relapse and total healthcare expenditures. Cox Proportional Hazards ratios for patients treated with either methadone or buprenorphine showed approximately 50% lower risk of relapse than behavioral treatment without OAT. Expenditures per month were from $153 to $233 lower for OAT episodes compared to other behavioral treatment. Co-occurring alcohol abuse/dependence quadrupled the risk of relapse, other non-opioid abuse/dependence doubled the relapse risk and severe mental illness added 80% greater risk compared to those without each of those disorders. Longer current treatment episodes were associated with lower risk of relapse. Relapse risk increased as prior treatment exposure increased but prior treatment was associated with slightly lower total healthcare expenditures. These findings suggest that the effectiveness of OAT that has been demonstrated in clinical trials persists at the population level in a less controlled setting and that OAT is associated with lower total healthcare expenditures compared to other forms of behavioral treatment for patients with opioid addiction. Co-occurring other substance use and mental illness exert strong influences on cost and risk of relapse, suggesting that individuals with these conditions need more comprehensive treatment.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School; Department of Quantitative Health Sciences, University of Massachusetts Medical School. Electronic address: robin.clark@umassmed.edu.
authors.forename: Robin E
authors.initials: RE
authors.lastname: Clark
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School; Center for Health Policy and Research, University of Massachusetts Medical School.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Baxter
authors.affiliation: Center for Health Policy and Research, University of Massachusetts Medical School.
authors.forename: Gideon
authors.initials: G
authors.lastname: Aweh
authors.affiliation: Center for Health Policy and Research, University of Massachusetts Medical School.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Connell
authors.affiliation: School of Criminology and Justice Studies, University of Massachusetts Lowell.
authors.forename: William H
authors.initials: WH
authors.lastname: Fisher
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School; Center for Health Policy and Research, University of Massachusetts Medical School.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Barton
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use*; D001521:Behavior Therapy / Q000191:economics / Q000706:statistics & numerical data*; D002047:Buprenorphine / Q000191:economics / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D008691:Methadone / Q000191:economics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000191:economics / Q000706:statistics & numerical data*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D012008:Recurrence; D012307:Risk Factors; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone
keywords: Buprenorphine; Cost; Economic evaluation; Length of treatment; Medicaid; Methadone; Opioid addiction; Opioid agonists; Public policy; Substance abuse treatment; Treatment history