National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK.
Drug Alcohol Rev. 2024 Nov;43(7):1845-1855. doi: 10.1111/dar.13933. Epub 2024 Aug 23.
More evidence for patterns of healthcare utilisation and associated costs among people receiving opioid agonist therapy (OAT) is needed. We investigated primary and secondary healthcare usage and costs among methadone and buprenorphine recipients in England.
We conducted a cohort study using the Clinical Practice Research Datalink GOLD and Aurum databases of patients who were prescribed OAT between 1 January 2007 and 31 July 2019. The cohort was linked to Hospital Episode Statistics admitted patient care, outpatient and emergency department data, neighbourhood- and practice-level Index of Multiple Deprivation quintiles and mortality records. Negative binomial regression models were applied to estimate weighted rate ratios (wRR) of healthcare utilisation. Total and mean costs were calculated using Unit Costs of Health and Social Care and the National Healthcare Service Payment by Results National Tariffs.
Among 12,639 patients observed over 39,016 person-years, we found higher rate of hospital admissions (wRR 1.18; 1.08-1.28) among methadone compared with buprenorphine recipients. The commonest hospital discharge diagnoses among methadone patients were infectious diseases (19.2%), mental and behavioural disorders (17.0%) and drug-related poisoning (16.5%); the three commonest among buprenorphine patients were mental and behavioural diseases (21.5%), endocrine (13.8%) and genitourinary system diseases (13.1%). Methadone patients had similar mean costs compared with buprenorphine patients (cost difference: £539.01; 432.11-1006.69).
Differences in healthcare utilisation frequency for methadone versus buprenorphine recipients were observed. The differences in associated costs were mainly driven by hospital admissions. These findings offer valuable insights for optimising care strategies and resource allocation for OAT recipients.
需要更多证据来证明接受阿片类激动剂治疗（OAT）的人群的医疗保健利用模式和相关成本。我们调查了英格兰接受美沙酮和丁丙诺啡治疗的患者的初级和二级医疗保健使用情况和费用。
我们使用 Clinical Practice Research Datalink GOLD 和 Aurum 数据库进行了一项队列研究，该数据库纳入了 2007 年 1 月 1 日至 2019 年 7 月 31 日期间接受 OAT 治疗的患者。该队列与医院入院统计数据、门诊和急诊科数据、社区和实践层面的多重剥夺五分位数以及死亡率记录相关联。应用负二项回归模型估计医疗保健利用的加权率比（wRR）。使用健康和社会护理单位成本和国家医疗服务按成果支付国家关税计算总费用和平均费用。
在观察的 12639 名患者中，他们在 39016 人年中发现美沙酮患者的住院率更高（wRR 1.18；1.08-1.28）。美沙酮患者最常见的出院诊断为传染病（19.2%）、精神和行为障碍（17.0%）和药物相关中毒（16.5%）；丁丙诺啡患者最常见的三种诊断为精神和行为疾病（21.5%）、内分泌（13.8%）和泌尿系统疾病（13.1%）。美沙酮患者的平均费用与丁丙诺啡患者相似（费用差异：539.01 英镑；432.11-1006.69）。
观察到美沙酮与丁丙诺啡患者之间医疗保健利用频率的差异。相关成本的差异主要由住院治疗引起。这些发现为优化 OAT 接受者的护理策略和资源分配提供了有价值的见解。
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