Physician Barriers
     
       Since 2003, a new form of treatment for opioid dependence called buprenorphine-medication assisted treatment has become increasingly available in the United States. However, little is known about the drivers of physician decisions and buprenorphine practice patterns. Health Analytics partnered with Magellan Health Services, a major managed behavioral health organization, to examine the practice patterns of physicians who are waivered to prescribe buprenorphine for the treatment of opioid dependence. Attitudes, beliefs, and practice patterns were measured on a sample of psychiatrists recruited from the Magellan Health Services network to better understand psychiatrist barriers to increasing the number of their opioid dependent patients that they treat using buprenorphine.
       An article was published in a 2010 issue of Journal of Addiction Medicine describing physician barriers. Among the major barriers to prescribing buprenorphine was the fear of medication diversion by the patients, the attraction of more substance abusing patients to the practice, and concerns about DEA intrusion.

HereToHelp^TM

       HereToHelp^TM is a confidential, outbound, telephonic support program designed to provide encouragement to opioid dependent patients new to buprenorphine-medication assisted treatment and also to help them resolve problems inherent to early treatment. Once enrolled in this program, patients are contacted by their "Care Coach" 2-3 times per month during the first three months of treatment. The HereToHelp^TM program provides support in three key areas: education about opioid dependence and treatment; assistance resolving challenges within treatment; and encouragement to stay in treament. Sponsored by Reckitt Benckiser Pharmaceuticals, Health Analytics conducted the pilot study of this new disease management study.
       An article was published in a 2010 issue of Journal of Substance Abuse Treatment detailing the methodology behind the pilot study of the HereToHelp^TM program. A total of 324 physicians from 40 states successfully recruited new buprenorphine patients into the study. Overall, 1,426 patients enrolled in the study and completed the baseline measure. Nearly 70% follow-up was achieved at each the 1, 2, and 3 month post-baseline measurement periods. A second manuscript has been accepted for publication in American Journal on Addictions focusing on the relationship between buprenorphine compliance and relapse to opioid use. Results of this study show that buprenorphine compliant patients are more than 10 times less likely to relapse to opioid use than patients who are non-compliant.

Economic Analyses

       Buprenorphine-medication assisted treatment is an effective treatment for opioid dependence, but may be considered cost-prohibitive by patients and health plans who manage its use based on ingredient cost alone. Health Analytics has partnered with a number of national health maintenance organizations to conduct various pharmacoeconomic analyses in the area of opioid dependence treatment. Adherence analyses were conducted for opioid dependent United Healthcare and Aetna members receiving buprenorphine-medication assisted treatment. Results revealed similar patterns across both health plans. Compared to non-compliant members, buprenorphine compliant members tend to have a higher number of visits to the pharmacy, but significantly less inpatient hospital admissions and emergency room visits, resulting in a net economic benefit to the payer.Health Analytics found that overall, buprenorphine compliant United members cost $8,534 less per member per 6 month period compared to non-compliant members. Similarly, we found that buprenorphine compliant Aetna members cost $14,448 less per member per 6 month period compared to non-compliant members. Results of the analyses of the United data were presented at the 2010 American Academy of Addiction Psychiatry meeting, and the Aetna results were accepted for presentation at the 2011 Academy of Managed Care Pharmacy annual meeting.