Rates and costs of drug testing practices for private payors in the outpatient setting in the United States, 2015-2019.

Autor: Barenie RE; University of Tennessee Health Science Center College of Pharmacy, 881 Madison Ave, Memphis, TN 38163, United States of America. Electronic address: rbarenie@uthsc.edu., Bateman BT; Perioperative and Pain Medicine and Chair of the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine; 300 Pasteur Dr Rm H3589, Stanford, CA 94305, United States of America. Electronic address: btb@stanford.edu., Connery HS; Clinical Director of Division of Alcohol, Drugs, and Addiction, 115 Mill Street, Belmont, MA 02478, United States of America. Electronic address: hconnery@mclean.harvard.edu., Tsacogianis T; Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St., Suite 3030, Boston, MA 02120, United States of America. Electronic address: ttsacogianis@bwh.harvard.edu., Kesselheim AS; Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St., Suite 3030, Boston, MA 02120, United States of America. Electronic address: akesselheim@bwh.harvard.edu.
Jazyk: angličtina
Zdroj: Journal of substance use and addiction treatment [J Subst Use Addict Treat] 2024 Apr; Vol. 159, pp. 209243. Date of Electronic Publication: 2023 Dec 03.
DOI: 10.1016/j.josat.2023.209243
Abstrakt: Introduction: Clinical practice guidelines recommend drug testing patients who are receiving opioids chronically for pain or medication for a substance use disorder (SUD)-particularly opioid use disorder (OUD)-but practices vary due to a lack of consensus on testing frequency during follow-up. This study aimed to evaluate rates and costs of outpatient drug testing practices for patients receiving opioids for chronic pain or medication for an SUD.
Methods: Using claims data from a large de-identified claims data warehouse, we conducted a retrospective cohort study of chronic opioid, buprenorphine, and naltrexone users between January 2015 and December 2019. We identified two cohorts-chronic opioid medication cohort (CO) and SUD-indicated medication cohort (SUD). We assessed drug testing rates during follow-up using procedure codes and costs using copayment, deductible, co-insurance, and out-of-pocket data.
Results: Among 6,657,515 eligible claimants, 367,118 (5.5 %) received opioids chronically and 73,303 (1.1 %) received an SUD-indicated medication. The cumulative proportion of drug testing during follow-up was similar between cohorts (CO: 36 %; SUD: 35 %), but rate of testing was consistently twice as frequent for the SUD cohort. All cost variables for the first drug test were higher on average in the SUD cohort than the CO cohort except copay: deductible (SUD: $18.54; CO: $7.33); co-insurance (SUD: $10.36; CO: $2.53); out-of-pocket (SUD: $29.39; CO: $10.57); copay (CO: $0.71; SUD: $0.49) (all p < 0.001).
Conclusions: Overall proportion of drug testing was similar between cohorts, but testing frequency was at least double during follow-up in the SUD cohort. Most cost variables were higher in the SUD cohort. Whether the high cost of drug testing is a barrier to medication use or is associated with treatment discontinuation should be evaluated.
Competing Interests: Declaration of competing interest REB and BTB serve as clinical consultants to Alosa Health for opioid use disorder and pain management-related work. HSC serves as clinical consultant to Alosa Health for opioid use disorder treatment. BTB is a co-investigator on grants to his institution from Eli Lilly, GSK, Pfizer, Pacira, and Baxalta. He is a consultant to Aetion, Inc. for unrelated work. ASK reports serving as an expert witness for the class of state plaintiffs in the multidistrict opiate litigation (2018–2019). TT declares no conflicts of interest.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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