Health Analytics, LLC, 9200 Rumsey Rd, Ste 215, Columbia, MD 21045. E-mail:
Am J Manag Care. 2017 Jun 1;23(6):e172-e179.
To examine patient characteristics and outcomes associated with nonadherence to buprenorphine and to identify specific patterns of nonadherent behavior.
Cross-sectional, retrospective analysis of health claims data.
Aetna's administrative claims data were used to categorize incident opioid use disorder (OUD) patients based on buprenorphine medication possession ratio (MPR) into adherent (n = 172) and nonadherent (n = 305) groups. Adherent groups were then divided into 5 subgroups based on level of MPR, as well as 2 a priori-defined groups: intermittent adherent (IA) and early treatment discontinuation-no consequences (ETDNC). Groups were compared on patient characteristics and outcomes.
Nonadherent members incurred significantly greater healthcare costs and were more likely to relapse (P <.05). The use of high-cost healthcare services increased as a function of decreasing MPR (P <.05). Assessment of the a priori groups revealed IA members to have outcomes similar to nonadherent patients, while ETDNC members exhibited outcomes similar to adherent members.
Administrative claims can be used to define subgroups of buprenorphine-medication assisted treatment (B-MAT) patients. Nonadherence was related to an increased likelihood of relapse, and there is an inverse relationship between MPR and cost. The heterogeneity observed within this sample indicates that treatment regimens effective for 1 subgroup may not be appropriate for all OUD patients. Increased understanding of B-MAT nonadherent subgroups may facilitate development of new interventions and medications specifically designed for nonadherent B-MAT patients, potentially leading to improved outcomes and reduced costs of care.
考察与丁丙诺啡不依从相关的患者特征和结局，并确定不依从行为的具体模式。
横断面、回顾性分析健康索赔数据。
利用 Aetna 的管理索赔数据，根据丁丙诺啡用药维持率（MPR）将新发阿片类使用障碍（OUD）患者分为依从组（n = 172）和不依从组（n = 305）。然后，根据 MPR 水平将依从组进一步分为 5 个亚组，并根据 2 个预先定义的组进行分类：间歇性依从（IA）和早期治疗中断无后果（ETDNC）。比较组间患者特征和结局。
不依从者的医疗费用显著增加，且更有可能复发（P <.05）。随着 MPR 的降低，高成本医疗服务的使用呈增加趋势（P <.05）。对预先定义的组进行评估发现，IA 组的结局与不依从组相似，而 ETDNC 组的结局与依从组相似。
行政索赔可用于定义丁丙诺啡药物辅助治疗（B-MAT）患者的亚组。不依从与复发的可能性增加有关，且 MPR 与成本呈负相关。该样本中观察到的异质性表明，对 1 个亚组有效的治疗方案可能不适合所有 OUD 患者。对 B-MAT 不依从亚组的进一步了解可能有助于为不依从的 B-MAT 患者开发新的干预措施和药物，从而有可能改善结局并降低医疗成本。
