ABSTRACT

Introduction

Buprenorphine medication assisted treatment (B-MAT) adherence for opioid use disorder (OUD) is suboptimal. reSET-O, an FDA-cleared prescription digital therapeutic, delivers neurobehavioral therapy (community-reinforcement approach+fluency training+contingency management) to B-MAT-treated OUD patients.

Methods

This retrospective claims study (10/01/2018-10/31/2019) evaluated healthcare resource utilization up to 6 months before/after reSET-O initiation. Repeated-measures negative binomial models compared incidences of encounters/procedures. Net change in costs was assessed.

Results

Among 351 patients (mean age 37; 59.5% female; 82.6% Medicaid), 334 had pharmacy claims and 240 (71.9%) received buprenorphine pre-/post-index (medication possession ratio 0.73 and 0.82, respectively; P = 0.004). Facility encounters decreased, with 45 fewer inpatient (P = 0.024) and 27 fewer emergency department (ED) visits (P = 0.247). Clinical encounters with largest changes were drug testing (638 fewer; P < 0.001), psychiatry (349 fewer; P = 0.036), case management (176 additional; P = 0.588), other pathology/laboratory (166 fewer; P = 0.039), office/other outpatient (154 fewer; P = 0.302), behavioral rehabilitation (111 additional; P = 0.124), alcohol/substance rehabilitation (96 fewer; P = 0.348), other rehabilitation (66 fewer; P = 0.387), mental health rehabilitation (61 additional; P = 0.097), and surgery (60 fewer; P = 0.070). Changes in facility/clinical encounters saved $2,150/patient.

Conclusion

reSET-O initiation was associated with fewer inpatient, ED, and other clinical encounters, increased case management/rehabilitative services, and lower net costs over six months.

Expert Opinion

Real-world evidence is helpful in evaluating the effectiveness of interventions in usual-care conditions, outside of controlled research environments. Large observational studies based on health care claims are important to understand the actual pharmacoeconomic and outcomes impact of interventions at the health care system and population level.

中文翻译：

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使用新型处方数字疗法 reSET-O 治疗阿片类药物使用障碍后，医疗资源利用率的实际减少

摘要

介绍

阿片类药物使用障碍 (OUD) 的丁丙诺啡药物辅助治疗 (B-MAT) 依从性欠佳。reSET-O 是一种 FDA 批准的处方数字治疗药物，为 B-MAT 治疗的 OUD 患者提供神经行为治疗（社区强化方法+流畅性培训+应急管理）。

方法

这项回顾性索赔研究 (10/01/2018-10/31/2019) 评估了 reSET-O 启动前后长达 6 个月的医疗资源利用率。重复测量负二项式模型比较了遭遇/程序的发生率。评估了成本的净变化。

结果

在 351 名患者（平均年龄 37 岁；59.5% 女性；82.6% 医疗补助）中，334 名有药房索赔，240 名（71.9%）接受了丁丙诺啡前/后指数（药物拥有率分别为 0.73 和 0.82；P =  0.004）。设施遭遇减少，住院患者减少 45 人 ( P =  0.024)，急诊 (ED) 就诊人数减少 27 人 ( P =  0.247)。变化最大的临床案例是药物检测（减少 638 人；P <  0.001）、精神病学（减少 349 人；P =  0.036）、病例管理（增加 176 人；P =  0.588）、其他病理学/实验室（减少 166 人；P =  0.039） , 门诊/其他门诊（少 154 人；P = 0.302），行为康复（增加 111；P =  0.124），酒精/药物康复（减少 96；P =  0.348），其他康复（减少 66；P =  0.387），心理健康康复（增加 61；P =  0.097），和手术（减少 60 人；P =  0.070）。设施/临床遭遇的变化为每位患者节省了 2,150 美元。

结论

reSET-O 启动与更少的住院、ED 和其他临床就诊、增加的病例管理/康复服务以及六个月内的净成本降低相关。

专家意见

真实世界的证据有助于评估在受控研究环境之外的常规护理条件下干预措施的有效性。基于医疗保健声明的大型观察性研究对于了解医疗保健系统和人群层面干预措施的实际药物经济学和结果影响非常重要。