scholarly journals Relationship between buprenorphine adherence and relapse, health care utilization and costs in privately and publicly insured patients with opioid use disorder

2018 ◽  
Vol Volume 9 ◽  
pp. 59-78 ◽  
Author(s):  
Naoko Ronquest ◽  
Tina Willson ◽  
Leslie Montejano ◽  
Vijay Nadipelli ◽  
Bernd Wollschlaeger
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Opioid Use Disorder ◽  
Care Utilization ◽  
Opioid Use ◽  
Publicly Insured ◽  
Insured Patients

scholarly journals Health care utilization and overall costs based on opioid dependence in patients undergoing surgery for degenerative spondylolisthesis

2018 ◽  
Vol 44 (5) ◽  
pp. E14 ◽  
Author(s):  
Mayur Sharma ◽  
Beatrice Ugiliweneza ◽  
Zaid Aljuboori ◽  
Maxwell Boakye
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Opioid Dependence ◽  
Degenerative Spondylolisthesis ◽  
Opioid Use Disorder ◽  
Hospital Length Of Stay ◽  
Care Utilization ◽  
Opioid Use ◽  
Opioid Dependency ◽  
Linear Contrasts

OBJECTIVEOpioid abuse is highly prevalent in patients with back pain. The aim of this study was to identify health care utilization and overall costs associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS).METHODSThe authors queried the MarketScan database using ICD-9 and CPT-4 codes from 2000 to 2012. Opioid dependency was defined as having a diagnosis of opioid use disorder, having a prescription for opioid use disorder, or having 10 or more opioid prescriptions. Opioid dependency was evaluated in 12-month period leading to surgery and in the period 3–15 months following the procedure. Patients were segregated into 4 groups based on opioid dependence before and after surgery: group NDND (prior nondependent who remain nondependent), group NDD (prior nondependent who become dependent), group DND (prior dependent who become nondependent), and group DD (prior dependent who remain dependent). The outcomes of interest were discharge disposition, hospital length of stay (LOS), complications, and health care resource costs. The 4 groups were compared using the Kruskal-Wallis test and linear contrasts built from generalized regression models.RESULTSA total of 10,708 patients were identified, with 81.57%, 3.58%, 8.54%, and 6.32% of patients in groups NDND, NDD, DND, and DD, respectively. In group DD, 96.31% of patients had decompression with fusion, compared with 93.59% in group NDND. Patients in group NDD, DND, and DD had longer hospital LOS compared with those in group NDND. Patients in group DD were less likely to be discharged home compared with those in group NDND (odds ratio 0.639, 95% confidence interval 0.52–0.785). At 3–15 months postdischarge, patients in group DD incurred 21% higher hospital readmission costs compared with those in group NDND. However, patients in groups NDD and DD were likely to incur 2.8 times the overall costs compared with patients in group NDND (p < 0.001) at 3–15 months after surgery (median overall payments: group NDD $20,033 and group DD $19,654, vs group NDND $7994).CONCLUSIONSPatients who continued to be opioid dependent or became opioid dependent following surgery for DS incurred significantly higher health care utilization and costs within 3 months and in the period 3–15 months after discharge from surgery.

scholarly journals Preexisting Opioid Use Disorder and Outcomes After Lower Extremity Arthroplasty: A Multistate Analysis, 2007–2014

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3624-3634
Author(s):  
Stephanie A Chen ◽  
Robert S White ◽  
Virginia Tangel ◽  
Soham Gupta ◽  
Jeffrey B Stambough ◽  
...  
Keyword(s):  
Health Care ◽  
Risk Factor ◽  
Postoperative Complications ◽  
Lower Extremity ◽  
Health Care Utilization ◽  
Hospital Mortality ◽  
Opioid Use Disorder ◽  
Care Utilization ◽  
Opioid Use ◽  
Present On Admission

Abstract Objective The aim of this study was to examine the association of preexisting opioid use disorder and postoperative outcomes in patients undergoing total hip or knee arthroplasty (THA and TKA, respectively) in the overall population and in the Medicare-only population. Methods This retrospective cohort study examined data from the State Inpatient Databases of the Healthcare Cost and Utilization Project for the years 2007–2014 from California, Florida, New York, Maryland, and Kentucky. We compared patients with and without opioid use disorders on unadjusted rates and calculated adjusted odds ratios (aORs) of in-hospital mortality, postoperative complications, length of stay, and 30-day and 90-day readmission status; analyses were repeated in a subgroup of Medicare insurance patients only. Subjects After applying our exclusion criteria, our study included 1,422,210 adult patients undergoing lower extremity arthroplasties, including 818,931 Medicare insurance patients. In our study, 0.4% of THA patients and 0.3% of TKA patients had present-on-admission opioid use disorder. Results Opioid use disorder patients were at higher risk for in-hospital mortality (aOR = 3.10), 30- and 90-day readmissions (aORs = 1.81, 1.81), and pulmonary and infectious complications (aORs = 1.25, 1.96). Conclusions Present-on-admission opioid use disorder was a risk factor for worse postoperative outcomes and increased health care utilization in the lower extremity arthroplasty population. Opioid use disorder is a potentially modifiable risk factor for mortality, postoperative complications, and health care utilization, especially in the at-risk Medicare population.

scholarly journals Relapse In Opioid Use Disorder: Implications For Health Care Utilization And Costs

2016 ◽  
Vol 19 (3) ◽  
pp. A188 ◽  
Author(s):  
B Brady ◽  
J Tkacz ◽  
V Nadipelli ◽  
J Volpicelli ◽  
N Ronquest ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Opioid Use Disorder ◽  
Care Utilization ◽  
Opioid Use

Treatment Persistence Among Insured Patients Newly Starting Buprenorphine/Naloxone for Opioid Use Disorder

2018 ◽  
Vol 52 (5) ◽  
pp. 405-414 ◽  
Author(s):  
Natalia Shcherbakova ◽  
Gary Tereso ◽  
Jacqueline Spain ◽  
Robert J. Roose
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Delivery ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Care Providers ◽  
Opioid Use ◽  
Treatment Persistence ◽  
Factors Associated ◽  
Insured Patients

Background: Persistence with medication-assisted therapy among patients with opioid use disorder has been associated with reduced likelihood of illicit opioid use. Objective: We aimed to describe treatment persistence and identify factors associated with 1-year persistence among insured patients newly initiating buprenorphine-containing pharmacotherapy. Methods: The retrospective observational cohort included employer-sponsored and managed Medicaid patients newly started on buprenorphine-containing therapy between June 30, 2010, and January 1, 2015. Persistence was measured as both a continuous and dichotomous variable (proportion of patients persistent for 1 year). Multivariable logistic regression analysis was used to identify factors associated with 1-year persistence. Results: A total of 302 patients met inclusion criteria. The median [range] number of treatment episodes was 1 [1-4]. Mean number of days on therapy during the first episode was 206 (SD = 152) days, with 40.4% (n = 122) of patients persisting for 1 year. Presence of concomitant fills of prescription opioid analgesics (odds ratio [OR] = 0.25; 95% CI = 0.12-0.51), being in care of an addiction specialist (OR = 0.40; 95% CI = 0.21-0.76), and Medicaid insurance coverage (OR = 0.33; 95% CI = 0.13-0.84) were significantly and negatively associated with 1-year persistence. There was also a strong inverse relationship between persistence and inpatient hospitalization (OR = 0.30; 95% CI = 0.12-0.76). Conclusions: Several health care delivery and use variables were significantly associated with nonpersistence. Concomitant use of prescription opioids is the most easily modifiable risk factor that health care providers and policy makers may act on to improve treatment continuation.

scholarly journals Barriers to Care and Health Care Utilization Among the Publicly Insured

Medical Care ◽  
2017 ◽  
Vol 55 (3) ◽  
pp. 207-214 ◽  
Author(s):  
Elizabeth M. Allen ◽  
Kathleen T. Call ◽  
Timothy J. Beebe ◽  
Donna D. McAlpine ◽  
Pamela Jo Johnson
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Barriers To Care ◽  
Care Utilization ◽  
Publicly Insured

Associations Between Practice-Reported Medical Homeness and Health Care Utilization Among Publicly Insured Children

2015 ◽  
Vol 15 (3) ◽  
pp. 267-274 ◽  
Author(s):  
Anna L. Christensen ◽  
Joseph S. Zickafoose ◽  
Brenda Natzke ◽  
Stacey McMorrow ◽  
Henry T. Ireys
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Publicly Insured
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