RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA.
RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA.
J Subst Use Addict Treat. 2023 Nov;154:209137. doi: 10.1016/j.josat.2023.209137. Epub 2023 Aug 7.
Few studies have examined the cost of medication for opioid use disorder (MOUD) with counseling for the adolescent and young adult population. This study calculated the health care utilization and cost of MOUD treatment, other substance use disorder treatment, and general health care for adolescents and young adults receiving treatment for opioid use disorder.
The study randomized youth ages 15 to 21 (N = 288) equally into the two study conditions: extended-release naltrexone (XR-NTX) or treatment as usual (TAU). While participants committed to treatment based on randomization the study observed considerable nonadherence to both randomized conditions. Instead of using the randomly assigned study conditions, we present descriptive costs by the type of MOUD treatment received: XR-NTX only, buprenorphine only, any other combination of MOUD treatments, and no MOUD. Health care use was aggregated over the 6-month period for each participant, and we calculated average/participant utilization for each treatment group. To determine participant costs, we multiplied the unit costs of health care services obtained from the literature by the reported amount of health care utilization for each participant. We then calculated the mean, standard error, median and IQR for MOUD costs, other substance use disorder treatment costs and general healthcare cost from the health care sector perspective.
On average, participants in the XR-NTX only group received 2.6 doses of XR-NTX (equivalent to approximately 78 days of treatment). The buprenorphine only group had an average of 97 days of buprenorphine treatment. The XR-NTX only group had higher/patient costs compared to participants in the buprenorphine only group ($10,491 vs. $8765) and higher XR-NTX utilization would further increase costs. Participants in the any other MOUD combination group had the highest total costs ($14,627) while participants in the no MOUD group at the lowest ($3453).
Our cost analysis calculates the real-world cost of MOUD treatment and, while not generalizable, provides policy makers an estimate of costs for adolescents and young adults. We found that participants in the XR-NTX only group received fewer days of medication compared to the buprenorphine only group, but their medication costs were higher due to the cost of XR-NTX injections. While the buprenorphine only group had the highest number of days of medication utilization of all the groups, the average number of days of medication utilization was considerably shorter than the six-month treatment period.
很少有研究检查过青少年和年轻成年人接受阿片类药物使用障碍（MOUD）咨询的药物治疗费用。本研究计算了接受 MOUD 治疗、其他物质使用障碍治疗和一般医疗保健的青少年和年轻成年人的医疗保健利用和成本，这些人接受了阿片类药物使用障碍的治疗。
该研究将 15 至 21 岁的青少年（N=288）随机平均分为两组：缓释纳曲酮（XR-NTX）或常规治疗（TAU）。虽然参与者根据随机分组承诺接受治疗，但对两种随机分组条件的依从性都很差。我们没有使用随机分配的研究条件，而是根据接受的 MOUD 治疗类型来介绍描述性成本：仅 XR-NTX、仅丁丙诺啡、任何其他 MOUD 治疗组合和无 MOUD。对每个参与者在 6 个月期间汇总了医疗保健的使用情况，并计算了每个治疗组的平均/参与者利用情况。为了确定参与者的成本，我们用从文献中获得的医疗服务单位成本乘以每个参与者报告的医疗保健利用量。然后，我们从医疗保健部门的角度计算了 MOUD 成本、其他物质使用障碍治疗成本和一般医疗保健成本的平均值、标准误差、中位数和 IQR。
平均而言，仅 XR-NTX 组的参与者接受了 2.6 剂 XR-NTX（相当于大约 78 天的治疗）。仅丁丙诺啡组的丁丙诺啡治疗平均为 97 天。仅 XR-NTX 组的患者成本高于仅丁丙诺啡组（$10491 比$8765），且 XR-NTX 的更多使用会进一步增加成本。任何其他 MOUD 联合治疗组的参与者总费用最高（$14627），而无 MOUD 组的参与者总费用最低（$3453）。
我们的成本分析计算了 MOUD 治疗的实际成本，虽然不具有普遍性，但为决策者提供了青少年和年轻成年人成本的估计。我们发现，仅 XR-NTX 组的参与者接受的药物治疗天数比仅丁丙诺啡组少，但由于 XR-NTX 注射的费用，他们的药物成本更高。虽然仅丁丙诺啡组所有组中药物利用天数最多，但药物利用天数的平均长度明显短于六个月的治疗期。
