Eleni Domzaridou, Thomas Allen, Matthew J. Carr, Tim Millar, Roger T. Webb, Darren M. Ashcroft
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The cohort was linked to Hospital Episode Statistics admitted patient care, outpatient and emergency department data, neighbourhood- and practice-level Index of Multiple Deprivation quintiles and mortality records. Negative binomial regression models were applied to estimate weighted rate ratios (wRR) of healthcare utilisation. Total and mean costs were calculated using Unit Costs of Health and Social Care and the National Healthcare Service Payment by Results National Tariffs.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 12,639 patients observed over 39,016 person-years, we found higher rate of hospital admissions (wRR 1.18; 1.08–1.28) among methadone compared with buprenorphine recipients. 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引用次数: 0
摘要
导言：我们需要更多的证据来证明接受阿片类激动剂治疗（OAT）者的医疗保健使用模式和相关费用。我们调查了英格兰美沙酮和丁丙诺啡接受者的初级和二级医疗保健使用情况及成本：我们利用临床实践研究数据链 GOLD 和 Aurum 数据库对 2007 年 1 月 1 日至 2019 年 7 月 31 日期间接受 OAT 治疗的患者进行了一项队列研究。该队列与医院事件统计（Hospital Episode Statistics）的住院病人护理、门诊和急诊科数据、邻里和实践层面的多重贫困指数五分位数以及死亡记录相关联。负二项回归模型用于估算医疗保健使用的加权比率（wRR）。总成本和平均成本采用《医疗与社会保健单位成本》（Unit Costs of Health and Social Care）和《国家医疗保健服务按效果付费国家收费标准》（National Healthcare Service Payment by Results National Tariffs）进行计算：在 39,016 人年中观察到的 12,639 名患者中，我们发现美沙酮患者的入院率（wRR 1.18；1.08-1.28）高于丁丙诺啡患者。美沙酮患者最常见的出院诊断是传染病（19.2%）、精神和行为障碍（17.0%）以及药物中毒（16.5%）；丁丙诺啡患者最常见的三种诊断是精神和行为障碍（21.5%）、内分泌疾病（13.8%）以及泌尿生殖系统疾病（13.1%）。美沙酮患者与丁丙诺啡患者的平均费用相似（费用差异：539.01英镑；432.11-1006.69英镑）：美沙酮患者与丁丙诺啡患者的医疗使用频率存在差异。相关费用的差异主要由入院治疗引起。这些发现为优化 OAT 受试者的护理策略和资源分配提供了宝贵的见解。
Healthcare utilisation and associated costs for methadone versus buprenorphine recipients: Examination of interlinked primary and secondary care electronic health records in England
Introduction
More evidence for patterns of healthcare utilisation and associated costs among people receiving opioid agonist therapy (OAT) is needed. We investigated primary and secondary healthcare usage and costs among methadone and buprenorphine recipients in England.
Methods
We conducted a cohort study using the Clinical Practice Research Datalink GOLD and Aurum databases of patients who were prescribed OAT between 1 January 2007 and 31 July 2019. The cohort was linked to Hospital Episode Statistics admitted patient care, outpatient and emergency department data, neighbourhood- and practice-level Index of Multiple Deprivation quintiles and mortality records. Negative binomial regression models were applied to estimate weighted rate ratios (wRR) of healthcare utilisation. Total and mean costs were calculated using Unit Costs of Health and Social Care and the National Healthcare Service Payment by Results National Tariffs.
Results
Among 12,639 patients observed over 39,016 person-years, we found higher rate of hospital admissions (wRR 1.18; 1.08–1.28) among methadone compared with buprenorphine recipients. The commonest hospital discharge diagnoses among methadone patients were infectious diseases (19.2%), mental and behavioural disorders (17.0%) and drug-related poisoning (16.5%); the three commonest among buprenorphine patients were mental and behavioural diseases (21.5%), endocrine (13.8%) and genitourinary system diseases (13.1%). Methadone patients had similar mean costs compared with buprenorphine patients (cost difference: £539.01; 432.11–1006.69).
Discussion and Conclusions
Differences in healthcare utilisation frequency for methadone versus buprenorphine recipients were observed. The differences in associated costs were mainly driven by hospital admissions. These findings offer valuable insights for optimising care strategies and resource allocation for OAT recipients.
期刊介绍：
Drug and Alcohol Review is an international meeting ground for the views, expertise and experience of all those involved in studying alcohol, tobacco and drug problems. Contributors to the Journal examine and report on alcohol and drug use from a wide range of clinical, biomedical, epidemiological, psychological and sociological perspectives. Drug and Alcohol Review particularly encourages the submission of papers which have a harm reduction perspective. However, all philosophies will find a place in the Journal: the principal criterion for publication of papers is their quality.
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