Total cost of care associated with opioid use disorder treatment

Abstract

The opioid epidemic in the United States disproportionately affects Medicaid beneficiaries than other groups. This results in a significant financial burden on state Medicaid programs. In this analysis, we investigate the association of medication for opioid use disorder (MOUD) treatment initiation and linkage to ongoing care on overall healthcare costs of Medicaid Fee-for-Service patients. We conducted a retrospective study among adult patients diagnosed with opioid use disorder (OUD) and who had a clinical encounter at a safety-net institution in Denver Colorado in 2020. Three categories of MOUD status of patients were defined: 1) identified with OUD but did not receive MOUD; 2) initiated MOUD but not linked to ongoing treatment and 3) received MOUD and linked to ongoing treatment. Our outcome variable was per-member per-month total healthcare cost. We estimated a multivariable model to test the association between healthcare cost and MOUD status, while controlling for demographic and risk classification variables. We found that in individuals with OUD who initiated MOUD treatment but were not linked to ongoing care had the highest healthcare cost, while those who were linked to ongoing MOUD treatment had the lowest healthcare cost. MOUD treatment is not only effective at addressing the significant morbidity and mortality burden of OUD but also associated with decreased financial cost, which is disproportionately incurred by Medicaid. Additional policy and care delivery changes are needed to focus efforts to improve linkage to ongoing treatment.

Keywords: Healthcare cost; Medicaid; Medication for opioid use disorder.

Figure 1

Marginal^a estimates of average per-member per-month (PMPM) healthcare costs based on Medication for Opioid Use Disorder (MOUD) status^b groups for Medicaid Fee-for-service enrollees who were identified with opioid use disorder (OUD) at Denver Health (DH) during 2020. Marginal estimates are displayed with their 95% confidence intervals. Notes: Data sources – Medicaid FFS claims and electronic health records at Denver. ^a Predictions based on Multivariable Generalized Linear Model (GLM) with log link and gamma distribution. This model controls for member’s age, sex, race/ethnicity and CRG health status. Using the estimated model, we calculated the average marginal effects of MOUD status on PMPM cost. ^b MOUD Status is categorized as follows: No MOUD = Identified with opioid use disorder but did not receive MOUD, MOUD not linked = Received MOUD but not linked to ongoing treatment, and MOUD linked = Received MOUD and linked to ongoing treatment. Linked to ongoing treatment defined as someone who received dose/s at an outpatient area at DH