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Out-of-pocket expenses may deter privately-insured patients from continuing treatment for opioid-use disorders

In a new study, Penn State researchers examine the impact that out-of-pocket expenses could have on treatment retention for those with opioid-use disorders.

In the project, Edeanya Agbese, MPH, research project manager in Penn State College of Medicine’s Department of Public Health Sciences, and Douglas Leslie, PhD, chief of the Division of Health Services and Behavioral Research in the department, examine the relationship between early discontinuation of buprenorphine and expenditures for privately-insured patients receiving care for opioid-use disorders (OUDs).

The research analyzes data from 6,444 privately-insured adults who initiated treatment with buprenorphine for OUDs in 2013. Patients had continuous insurance coverage for three months prior to receiving buprenorphine and for at least 12 months afterward.

Researchers compared medication and health service expenditures before and after treatment initiation across four patient groups based on their length of treatment with buprenorphine (0 to 3 months, 3 to 6 months, 6 to 12 months and 12 or more months). Findings show that annual health care expenditures were highest ($29,521) for patients with the poorest buprenorphine retention. However, these individuals also had high medical expenditures prior to starting treatment ($7,588 vs. $4,929 for the group with the longest retention group).

In addition, annual medication expenditures for the sample averaged $5,007 (19% of health care expenditures) and buprenorphine accounted for 52% of medication costs. Unsurprising, medication costs were highest among those in the ≥12 month retention group. Average total out-of-pocket spending for the sample was high at $2,916 (or $243 per month), with $32 per month in buprenorphine spending.

The study suggests that for patients prescribed buprenorphine for OUDs, the cost burden may contribute to poor retention among privately-insured adults. A benefit of reducing such costs may be improved adherence to treatment.

The work, Early Discontinuation of Buprenorphine Therapy for Opioid Use Disorder Among Privately Insured Adults, was published in April in the journal Psychiatric Services.

For this research, Agbese and Leslie are joined by Drs. Ajay Manhapra and Robert Rosenheck, both from the U.S. Department of Veterans Affairs and the Department of Psychiatry at Yale School of Medicine.

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