2007 年至 2018 年阿片类药物使用障碍布比卡因治疗的国家趋势。
National Trends in Buprenorphine Treatment for Opioid Use Disorder From 2007 to 2018.
机构信息
RAND Corporation, Arlington, VA, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
出版信息
Subst Abus. 2023 Jul;44(3):154-163. doi: 10.1177/08897077231179576. Epub 2023 Jun 6.
BACKGROUND
Buprenorphine is a key medication to treat opioid use disorder (OUD). Since its approval in 2002, buprenorphine access has grown markedly, spurred by major federal and state policy changes. This study characterizes buprenorphine treatment episodes during 2007 to 2018 with respect to payer, provider specialty, and patient demographics.
METHODS
In this observational cohort study, IQVIA Real World pharmacy claims data were used to characterize trends in buprenorphine treatment episodes across four time periods: 2007-2009, 2010-2012, 2013-2015, and 2016-2018.
RESULTS
In total, we identified more than 4.1 million buprenorphine treatment episodes among 2 540 710 unique individuals. The number of episodes doubled from 652 994 in 2007-2009 to 1 331 980 in 2016-2018. Our findings indicate that the payer landscape changed dramatically, with the most pronounced growth observed for Medicaid (increased from 17% of episodes in 2007-2009 to 37% of episodes in 2016-2018), accompanied by relative declines for both commercial insurance (declined from 35 to 21%) and self-pay (declined from 27 to 11%). Adult primary care providers (PCPs) were the dominant prescribers throughout the study period. The number of episodes among adults older than 55 increased more than 3-fold from 2007-2009 to 2016-2018. In contrast, youth under age 18 experienced an absolute decline in buprenorphine treatment episodes. Buprenorphine episodes increased in length from 2007-2018, particularly among adults over age 45.
CONCLUSIONS
Our findings demonstrate that the U.S. experienced clear growth in buprenorphine treatment-particularly for older adults and Medicaid beneficiaries-reflecting some key health policy and implementation success stories. Yet, since the prevalence of OUD and fatal overdose rate have also approximately doubled during this period, the observed growth in buprenorphine treatment did not demonstrably impact the pronounced treatment gap. To date, only a minority of individuals with OUD currently receive treatment, indicating continued need for systemic efforts to equitably improve treatment uptake.
背景
丁丙诺啡是治疗阿片类药物使用障碍（OUD）的关键药物。自 2002 年批准以来，由于主要的联邦和州政策变化，丁丙诺啡的使用显著增加。本研究描述了 2007 年至 2018 年期间丁丙诺啡治疗的支付方、提供者专业和患者人口统计学特征。
方法
在这项观察性队列研究中，使用 IQVIA Real World 药房理赔数据来描述四个时期内丁丙诺啡治疗的趋势：2007-2009 年、2010-2012 年、2013-2015 年和 2016-2018 年。
结果
我们共确定了 410 多万例丁丙诺啡治疗，涉及 2540710 名独特个体。从 2007-2009 年的 652994 例增加到 2016-2018 年的 1331980 例，治疗次数翻了一番。我们的研究结果表明，支付方格局发生了巨大变化，医疗补助的增长最为显著（从 2007-2009 年的 17%增加到 2016-2018 年的 37%），商业保险（从 35%下降到 21%）和自付（从 27%下降到 11%）相对下降。成年初级保健提供者（PCP）是整个研究期间的主要处方者。2007-2009 年至 2016-2018 年，55 岁以上成年人的治疗次数增加了两倍多。相比之下，18 岁以下的年轻人的丁丙诺啡治疗次数绝对减少。从 2007 年至 2018 年，丁丙诺啡的治疗时间延长，特别是 45 岁以上的成年人。
结论
我们的研究结果表明，美国丁丙诺啡的治疗明显增加，尤其是老年患者和医疗补助受益人群，这反映了一些关键的卫生政策和实施成功案例。然而，在此期间，阿片类药物使用障碍的流行率和致命过量率也大约翻了一番，因此丁丙诺啡治疗的增加并没有明显缩小治疗差距。迄今为止，只有少数患有阿片类药物使用障碍的人接受治疗，这表明需要继续进行系统努力，以公平地提高治疗参与率。
Zotero 插件