Longitudinal Treatment Pathways Following Opioid Use Disorder Diagnosis Among Commercially-Insured Beneficiaries in the U.S.

Background: Early treatment initiation and retention are important elements of successful opioid use disorder (OUD) treatment. Up to 40–50% of patients with OUD discontinue OUD treatment, most within one month after diagnosis. The 12-month period following OUD diagnosis is critical to shaping a patient’s healthcare outcomes, with studies indicating that 12 months may indicate a minimum threshold for quality treatment.

Objectives: To describe the most common OUD treatment pathways among commercially-insured beneficiaries with OUD in the 12-month period after initial treatment.

Methods: 15-month, retrospective, longitudinal descriptive study of beneficiaries, 18-85 years of age, who had any OUD diagnosis in the IBM MarketScan® commercial claims dataset from 2010-2019, and were continuously enrolled 6-months before and 3-months after index date (OUD diagnosis date). Beneficiaries were assigned to the following initial 3-month, post-index date treatment categories: 1) Behavioral therapy (BHV) only, 2) Buprenorphine (BUP), 3) Buprenorphine and behavioral (BUP+BHV), 4) Naltrexone (NTX), 5) Naltrexone and behavioral (NTX+BHV), 6) Methadone with or without behavioral (MTD+/-BHV), 7) No treatment, and 8) Other treatment combinations. We characterized the monthly treatment and disenrollment patterns and summarized the treatment pathways for the 12-month period following the initial treatment assignment period.

Results: In a sample of 372,614 beneficiaries with an OUD diagnosis in the initial study period, there were a total of 51,492 distinct treatment pathways, of which 68 pathways included at least 1% of beneficiaries. With the exception of initial treatment exposures of NTX+/-BHV, the most common pathway for each of the initial 3-month treatment assignment categories involved beneficiaries remaining on that same treatment in the following 12 months. The proportion of beneficiaries with continued same treatment for 12 months after the initial 3-month period was 7.2% for those assigned BHV, 9.8% for BUP, 7.7% for BUP+BHV, and 17.8% for MTD+/-BHV. The most common pathway for the “no treatment” category involved no treatment throughout the entire follow-up period (17.9% of the “no treatment” category). For all initial exposure categories, the 2nd and 3rd most common pathways involved early disenrollment or discontinuation of OUD treatment.

Conclusions: We found great variation in longitudinal treatment pathways for OUD. While the most common pathways from each treatment category assigned initially showed continued utilization of the same treatment over the 1-year period, these pathways only comprised < 10-20% of beneficiaries. This suggests that the majority of beneficiaries do not remain on the same treatment throughout the year.