Association between extended-release buprenorphine adherence and reduced healthcare costs among insured patients with opioid use disorder

Purpose: To evaluate the relationship between adherence to extended-release buprenorphine (BUP-XR; SUBLOCADE®) and reduced healthcare utilization and medical costs among patients with opioid use disorder (OUD). Methods: This retrospective analysis of United States insurance claims included patients aged ≥18 years who initiated BUP-XR between 3/1/2019-12/31/2022 (index = earliest BUP-XR claim) in the Merative™ MarketScan® Commercial and Medicare Databases. Patients had continuous enrollment (medical, pharmacy, and behavioral benefits) for 12 months before (baseline period) and 12 months after (follow-up period) the index date. Proportion of days covered (PDC) was used to assess adherence to both BUP-XR and medications for OUD (MOUD) overall during the follow-up period. Patients were assigned to four mutually-exclusive groups: Group 1 (adherent [PDC ≥ 0.8] to BUP-XR treatment); Group 2 (non-adherent to BUP-XR but adherent to overall MOUD); Group 3 (non-adherent to overall MOUD and primarily treated with BUP-XR); Group 4 (non-adherent to overall MOUD and not primarily treated with BUP-XR). Descriptive and adjusted analyses compared total non-MOUD costs in the follow-up period of Group 1 (reference) to the other groups. Results: Of 661 patients, 24.7% were adherent to BUP-XR (Group 1) during the 12-month follow-up period (Group 2: 17.1%, Group 3: 39.9%, Group 4: 18.3%). Compared to other groups, patients adherent to BUP-XR (Group 1) had the lowest rates of inpatient, emergency department, and detoxification visits. Adjusted non-MOUD costs during the 12-month follow-up period were $35,761 (Group 1), $50,778 (Group 2), $29,599 (Group 3), and $44,739 (Group 4). Despite both groups having PDC ≥ 0.8, patients adherent to BUP-XR (Group 1) had $15,017 reduced costs per person compared to those adherent to overall MOUD (Group 2). The lower adjusted costs observed in Groups 3 and 4 reflected patient disengagement from care, characterized by substantially fewer outpatient services and higher acute care utilization. Conclusion: Sustained BUP-XR adherence reduced costly medical utilization compared to non-adherence to BUP-XR while maintaining adherence to overall MOUD.