Extended-Release Buprenorphine Adherence Linked to Lower Health Care Utilization in OUD

Key Takeaways:

• Patients with opioid use disorder (OUD) who maintained adherence to extended-release buprenorphine (BUP-XR) had lower rates of acute care utilization, indicating a lower risk of medical emergencies.
• BUP-XR adherence was associated with lower care costs per patient than adherence to overall OUD medications (MOUD), suggesting BUP-XR is a more clinically and economically effective therapy option.
• Disengagement from care was associated with higher care costs and higher rates of acute care utilization, highlighting the importance of expanding care access and increasing treatment adherence for patients with OUD.

In the US, approximately 1.7% or 4.8 million individuals were impacted by OUD in 2024. Despite the approval of several effective MOUD such as methadone, transmucosal buprenorphine (TM-BUP), naltrexone (NTX-XR), and BUP-XR, treatment utilization remains suboptimal, with only 1 in 5 patients receiving medication.

Adherence to MOUD has been associated with improved health outcomes and reduced economic burden. Researchers evaluated the relationship between BUP-XR adherence and health care utilization and spending among patients with OUD.

Study Methods and Outcomes

Using administrative claims data from the Merative MarketScan Commercial and Medicare databases, investigators identified 661 patients aged 18 or older who initiated BUP-XR between March 2019 and December 2022. Treatment adherence was assessed by the proportion of days covered (PDC) over 12 months.

Patients were categorized into 4 groups:

• Group 1: BUP-XR adherence (PDC ≥ 0.8)
• Group 2: non-adherent to BUP-XR but adherent to overall MOUD
• Group 3: non-adherent to overall MOUD and primarily treated with BUP-XR
• Group 4: non-adherent to overall MOUD and not primarily treated with BUP-XR

The study’s primary outcomes included health care utilization and total care costs across 4 categories: inpatient admissions, outpatients services, detoxification, and pharmacy.

Treatment Adherence

Among the 661 patients included in the study, 24.7% made up Group 1, 17.1% made up Group 2, 39.9% comprised Group 3, and 18.3% were in Group 4.

Over 12 months, patients in Group 1 maintained BUP-XR adherence, with PDC greater than 0.9 at both follow-ups. Group 2 had lower rates of BUP-XR adherence, which declined from 0.47 to 0.17 during the study, but maintained an overall MOUD adherence of PDC greater than 0.9 at both follow-ups.

Patients in Groups 3 and 4 had significant declines in both BUP-XR and overall MOUD adherence. In Group 3, overall MOUD adherence declined from 0.61 to 0.13. Group 4’s MOUD PDC declined from 0.66 to 0.33.

Health Utilization and Care Costs

Group 1 was associated with the lowest rates of inpatient, emergency department (ED), and detoxification visits, but had higher rates of outpatient visits and pharmacy claims compared to the other cohorts. Total care costs for this cohort were $44 851, with adjusted non-MOUD costs of $35 761. Overall, patients in this group had reduced spending of $15 017 compared to those in Group 2.

Group 2 had similar rates of outpatient visits and pharmacy claims with Group 1 and higher rates of acute care utilization, with 8.0% inpatient stays and 29.2% ED visits. Total care costs for this cohort were $41 779. Adjusted non-MOUD costs ($50 778) were higher compared to the other groups.

Group 3 also had high rates of acute care utilization, but this group had the lowest rates of outpatient utilization, with an average of 9.6 outpatient visits. This cohort had the lowest total care costs ($31 519) and adjusted non-MOUD costs ($29 599). However, this data likely reflects patient disengagement from care rather than increased cost savings, especially when considering this cohort’s low treatment adherence.

Group 4 was associated with the highest clinical and economic burden, with the highest rates of acute care (9.9% inpatient stays, 45.5% ED visits, and 39.7% detoxification visits). This cohort had the highest total care costs ($67 290), with adjusted non-MOUD costs of $44 739.

Implications for Managed Care

These findings demonstrate the association between BUP-XR treatment adherence and reduced health care utilization and medical costs.

Although patients with BUP-XR adherence accumulated higher total care costs and had more outpatient visits, they were at lower risk of requiring emergent care. In addition, BUP-XR adherence was associated with lower per-person spending compared to overall MOUD utilization, suggesting BUP-XR as a more cost-effective alternative for patients with OUD.

The authors said, “The real-world evidence generated from this analysis can inform public health strategies and payer policies on interventions with effective, long-acting OUD treatments.”

Initiatives aimed at raising awareness and reducing stigma around OUD, expanding access to MOUD, and addressing health disparities can help increase OUD treatment adherence and improve patient outcomes.

Reference

Jerry M, Venkat D, Flynn C, et al. Association between extended-release buprenorphine adherence and reduced healthcare costs among insured patients with opioid use disorder. Frontiers Public Health. 2026;14. doi:10.3389/fpubh.2026.1774410