Buprenorphine Therapy Associated With Lower Costs, Improved Outcomes

Douglas A. Nemecek, MD

Buprenorphine therapy with induction or noninduction, regardless of simultaneous naloxone, for patients with opioid dependence has been shown to result in improved costs, as well as better utilization of inpatient and outpatient services.

Buprenorphine induction was associated with a 19.3% reduction in total outpatient costs compared with a 23.7% increase in costs with the usual care. There was also an observed 59.4% decrease in solely medical outpatient costs associated with buprenorphine induction compared to a 24.2% increase with usual care.

Noninduction buprenorphine therapy was associated with a 44.1% decrease in outpatient office visits compared with a 1.7% increase in visits with usual care (rate ratio, 0.71 to 1; P <.05).

“This study demonstrates that with induction and maintenance treatment with buprenorphine for opioid use disorders, patients have both improved clinical outcomes and lower total medical costs,” study author Douglas A. Nemecek, MD, the chief medical officer for Cigna’s behavioral health business, told MD Magazine. “These results reinforce the idea that we must increase access and availability of buprenorphine management and medication-assisted treatment for patients with opioid use disorders.”

Conducted by Nemecek and colleagues Julie B. Kessel, MD, and Liana D. Castel, PhD, the study analyzed data from Cigna for almost 70,000 behavioral health administrative claims for 8503 adult patients with opioid dependence.

During analysis, the 648 patients that met the inclusion criteria were split into 3 groups: an induction group (n = 48), which received buprenorphine in the induction phase and continued to maintenance; a noninduction group (n = 241), which received buprenorphine as part of the detoxification process or during hospitalization; and a no treatment group (n = 359), which received usual care without buprenorphine.

“We found that the total costs of care for these customers, when looking at behavioral health, pharmacy, and medical spend, was significantly decreased for the customers treated with buprenorphine compared to customers who did not receive buprenorphine,” Nemecek said. “When treated with buprenorphine, total medical costs decreased by 50% after the customers began treatment.”

Both the induction and noninduction groups saw decreases in inpatient and outpatient costs (cost ratio, 0.52 to 1; P <.001), and behavioral health costs (cost ratio, 0.48 to 1; P <.05). As anticipated, behavioral health outpatient costs were higher for the induction group, but the difference between induction and noninduction was not statistically significant.

Increases were seen in total (92.7%; cost ratio, 1.58 to 1; P <.05) and nonpsychotropic (102.4%; cost ratio, 2.26 to 1; P <.0001) prescription costs for the induction group, most significantly in the posttreatment interval. No prescription differences were observed when comparing the noninduction and no treatment groups.

“I think one of the important findings with our study was that not only did patients treated with buprenorphine have better treatment outcomes for their opioid use disorder, but they also were more adherent to their medical care for other medical conditions they had, such as high blood pressure,” Nemecek said. “They were more adherent with their prescriptions for all of their medications, and their overall health was improved. So even though costs were higher for their pharmacy benefits, and they saw their physician more often for follow-up and they were in better health overall, leading to the total medical cost savings.”

Nemecek added that he hoped that more providers will start offering medication-assisted treatment for their patients with opioid use disorders and that physicians will understand the “critical need” to educate patients about medication-assisted therapy.

“It’s so important to understand that opioid use disorders, and all addiction, are a chronic illness and should be treated as such,” he said. “We must all join together to change the conversation to help decrease the stigma associated with opioid use disorders, and help more people seek and gain treatment that they need.”

The study, “Clinical and Cost Outcomes of Buprenorphine Treatment in a Commercial Benefit Plan Population,” was published in AJPB.

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