Hasan Md Mahmudul, Noor-E-Alam Md, Mohite Prathamesh, Islam Md Saiful, Modestino Alicia Sasser, Peckham Alyssa M, Young Leonard D, Young Gary J
Dept. of Mechanical and Industrial Engineering, College of Engineering, Center for Health Policy and Healthcare Research, Northeastern University, 360 Huntington Avenue, Boston, MA 02135, USA.
Dept. of Mechanical and Industrial Engineering, College of Engineering, Northeastern University, 360 Huntington Avenue, Boston, MA 02135, USA.
J Subst Abuse Treat. 2021 Dec;131:108416. doi: 10.1016/j.jsat.2021.108416. Epub 2021 Apr 20.
Research has shown buprenorphine/naloxone to be an effective medication for treating individuals with opioid use disorder. At the same time, treatment discontinuation rates are reportedly high though much of the extant evidence comes from studies of the Medicaid population.
To examine the pattern and determinants of buprenorphine/naloxone treatment discontinuation in a population of commercially insured individuals.
We performed a retrospective observational analysis of Massachusetts All Payer Claims Data (MA APCD) covering years 2013 through 2017. We defined treatment discontinuation as a gap of 60 consecutive days without a prescription for buprenorphine/naloxone within a time frame of 24 months from the initiation of treatment. A mixed-effect Cox proportional hazard model examined the associated risk of discontinuing treatment with baseline predictors.
A total of 5134 individuals who were commercially insured during the study period.
Buprenorphine/naloxone treatment discontinuation.
Overall 75% of individuals had discontinued treatment within two years of initiating treatment, and median time to discontinuation was 300 days. Patients aged between 18 and 24 years (HR = 1.436, 95%, CI = 1.240-1.663) and receiving treatment from prescribers with high panel-size (HR = 1.278, 95% CI = 1.112-1.468) had higher risk of discontinuing treatment. On the contrary, patients receiving treatment from multiple prescribers had lower associated risk of treatment discontinuation.
A substantial percentage of patients discontinue treatment well before they can typically meet criteria for sustained remission. Further investigations should assess the clinical outcomes following premature discontinuation and identify strategies for retaining patients in treatment.
研究表明，丁丙诺啡/纳洛酮是治疗阿片类药物使用障碍患者的有效药物。与此同时，据报道治疗中断率很高，尽管现有证据大多来自对医疗补助人群的研究。
研究商业保险人群中丁丙诺啡/纳洛酮治疗中断的模式和决定因素。
我们对2013年至2017年的马萨诸塞州全支付方索赔数据（MA APCD）进行了回顾性观察分析。我们将治疗中断定义为在开始治疗后的24个月时间范围内，连续60天没有丁丙诺啡/纳洛酮处方。一个混合效应Cox比例风险模型检验了与基线预测因素相关的治疗中断风险。
在研究期间共有5134名商业保险患者。
丁丙诺啡/纳洛酮治疗中断情况。
总体而言，75%的患者在开始治疗后的两年内中断了治疗，中断治疗的中位时间为300天。年龄在18至24岁之间的患者（风险比[HR]=1.436，95%置信区间[CI]=1.240-1.663）以及接受高患者量开处方者治疗的患者（HR=1.278，95%CI=1.112-1.468）中断治疗的风险更高。相反，接受多个开处方者治疗的患者治疗中断的相关风险较低。
相当大比例的患者在通常能够达到持续缓解标准之前就中断了治疗。进一步的研究应评估过早中断治疗后的临床结果，并确定让患者继续接受治疗的策略。
