Association between buprenorphine adherence for opioid use disorder and clinical events and healthcare spending among older patients

Abstract

Background

Buprenorphine adherence in older adults with opioid use disorder (OUD) remains underexplored. This study investigated the associations between buprenorphine adherence and risks of opioid overdose, hospitalization, and healthcare spending among older adults to help inform practice and policy.

Methods

In this retrospective cohort study, we utilized the Merative MarketScan® Database (2017–2019) to identify Medicare Advantage enrollees with OUD who initiated buprenorphine and were retrospectively followed for 180 days. We classified patients as adherent (Proportion of Days Covered ≥0.80) or non-adherent to buprenorphine. We balanced baseline characteristics between groups using an inverse probability treatment weighting approach. We then evaluated the associations between adherence and the risks of opioid overdose and all-cause hospitalization using discrete-time survival and Cox proportional hazards models respectively. Finally, we estimated differences in healthcare spending between adherent and non-adherent patients using generalized linear models.

Results

The cohort included 631 patients (379 [60 %] male; mean (SD) age:67 [2.8] years). Among them, 437 (69 %) were adherent to buprenorphine. Patients with a history of chronic pain, mental health disorders, and diabetes were less likely to adhere while higher average daily doses of buprenorphine were associated with increased adherence. Adherence was associated with reduced risks of opioid overdose (HR:0.76; 95%CI:0.59–0.93) and hospitalization (HR:0.55; 95%CI:0.42–0.73). Healthcare spending among adherent patients was $40,200 [95%CI:$54,712-25,687]) lower than in non-adherent patients. These findings were consistent across robustness and sensitivity analyses.

Conclusions

Buprenorphine adherence was associated with reduced risks of opioid overdose, hospitalization, and healthcare spending in the overall population of older individuals with OUD. Enhancing adherence to buprenorphine should be prioritized in OUD treatment strategies among this population.