Liao Shirley, Jang Steve, Tharp Jordan A, Lester Natalie A
Verily, 269 E Grand Ave, South San Francisco, CA, United States of America.
Verily, 269 E Grand Ave, South San Francisco, CA, United States of America.
J Subst Use Addict Treat. 2023 Nov;154:209139. doi: 10.1016/j.josat.2023.209139. Epub 2023 Aug 23.
Medication for opioid use disorder (MOUD) has well-documented benefits for treating OUD, though its efficacy depends on patient adherence. We know little about outcomes of MOUD nonadherence compared to treatment regimens without MOUD, and this article aims to address the gap. This analysis focused on office-based MOUD treatment (buprenorphine and naltrexone) to evaluate the long-term impact of adherence on subsequent health care costs and health care events.
With claims data from 2017 to 2019, we used propensity score (PS) weighting to create three comparable cohorts of patients: 1) Adherent: filled MOUD prescription & ≧80 % of days covered by MOUD (N = 1045); 2) Nonadherent: filled MOUD & < 80 % of days covered (N = 1116), 3) did not fill MOUD (N = 16,784). The study defined three time intervals based on a patient's most recent MOUD episode: A 6-month baseline period before initiation of MOUD or random index date for those with MOUD; a 6-month treatment period, during which adherence or nonadherence was established; and a 12-month follow-up period to evaluate outcome measures. The study used generalized PS methodology to examine the effect of proportion of days covered (PDC) as a continuous measure of adherence.
Among patients who filled MOUD, adherence to MOUD was significantly predicted by having less severe OUD, being older, having fewer inpatient visits and lower outpatient costs before the start of treatment. Adherent patients displayed significantly lower health care costs in the follow-up period compared to nonadherent MOUD patients, and lower odds of experiencing health care events. The nonadherent MOUD group displayed significantly higher odds of health care events compared to patients who had no evidence of receiving MOUD in claims data (NO-MOUD). Among patients prescribed MOUD, each 10 % increase in PDC was associated with a significant decrease in inpatient/outpatient costs and in odds of health care events.
This analysis aligns with previous findings about the importance of maintaining long-term adherence to MOUD in supporting patient outcomes. The results also suggest a novel finding that despite confounder control via PS methods, nonadherent patients display poorer outcomes compared to similar NO-MOUD patients.
阿片类药物使用障碍药物治疗（MOUD）对治疗阿片类药物使用障碍具有充分记录的益处，但其疗效取决于患者的依从性。与未使用MOUD的治疗方案相比，我们对MOUD治疗不依从的结果知之甚少，本文旨在填补这一空白。该分析聚焦于基于门诊的MOUD治疗（丁丙诺啡和纳曲酮），以评估依从性对后续医疗保健成本和医疗保健事件的长期影响。
利用2017年至2019年的理赔数据，我们使用倾向评分（PS）加权法创建了三组可比的患者队列：1）依从组：开具了MOUD处方且MOUD覆盖天数≥80%（N = 1045）；2）不依从组：开具了MOUD处方但覆盖天数<80%（N = 1116）；3）未开具MOUD处方组（N = 16784）。该研究根据患者最近一次的MOUD治疗发作定义了三个时间间隔：对于接受MOUD治疗的患者，在开始MOUD治疗前或随机索引日期前的6个月基线期；确定依从或不依从情况的6个月治疗期；以及评估结局指标的12个月随访期。该研究使用广义PS方法，将覆盖天数比例（PDC）作为依从性的连续指标来检验其效果。
在开具了MOUD处方的患者中，阿片类药物使用障碍病情较轻、年龄较大、治疗开始前住院次数较少且门诊费用较低的患者，MOUD治疗依从性显著更高。与MOUD治疗不依从的患者相比，依从性好的患者在随访期的医疗保健成本显著更低，发生医疗保健事件的几率也更低。与理赔数据中无MOUD治疗证据的患者（无MOUD组）相比，MOUD治疗不依从组发生医疗保健事件的几率显著更高。在开具MOUD处方的患者中，PDC每增加10%，住院/门诊费用及发生医疗保健事件的几率就显著降低。
该分析与之前关于长期坚持MOUD治疗对支持患者预后的重要性的研究结果一致。研究结果还表明了一个新发现，即尽管通过PS方法控制了混杂因素，但与类似的无MOUD组患者相比，不依从的患者预后更差。
