Expert Review of Pharmacoeconomics & Outcomes Research | 2021
Evidence of long-term real-world reduction in healthcare resource utilization following treatment of opioid use disorder with reSET-O, a novel prescription digital therapeutic
Abstract
Evidence-based behavioral approaches for Opioid Use Disorder (OUD) are resource-intensive and challenging to implement, resulting in the majority of patients not receiving adequate care [1,2]. Medications for OUD (MOUD), primarily buprenorphine and methadone are critical to reduce cravings, but behavioral therapy, such as the evidence-based community reinforcement approach (CRA) for the treatment of substance use disorders (SUDs), is essential for durably reinforcing behaviors that support recovery [3]. Prescription digital therapeutics (PDTs) like reSET and reSET-O, are software-based disease treatments that deliver evidence-based therapeutic content and are authorized by the U.S. Food and Drug Administration (FDA) to treat adult patients with SUD and OUD, respectively. In addition to the therapeutic component these PDTs also provide patient support services with algorithmically driven outbound calls to foster engagement with therapy, and feature a dedicated clinician dashboard which allows clinicians to monitor patients’ progress in real time. Prescribed and initiated by treating clinicians, and delivered on mobile devices, reSET and reSET-O have the potential to safely expand access to evidence-based therapies, which is highly relevant in the context of limited access to clinicians [4–6]. In November 2020, we published in this journal a retrospective claims study evaluating changes in healthcare resource utilization following the initiation of reSET-O among 351 predominantly Medicaid-covered (82.6%) patients with OUD [7]. That analysis showed a net reduction in medical costs of 2,150 USD per patient 6 months post initiation of reSET-O, driven in large part by a reduction in inpatient (IP) stays and emergency department (ED) visits, but also by a reduced utilization of presumptive and definitive drug testing for a variety of substances, and through the substitution of face-to-face counseling sessions (CPT codes for individual and group psychotherapy: 90,785–90,876). Conversely, an increased utilization of case management and behavioral/ mental health rehabilitative services was observed, which together with a significant increase in buprenorphine adherence indicates a greater engagement with services supportive of long-term recovery. Here, we report an extended analysis in a larger OUD patient population (N = 444) with 9-month pre/post initiation claims data identified in the HealthVerity PrivateSource20 (PS20) database between 1 January 2019 and 8 December 2021, which supports the trends we observed in the 6-month analysis, suggesting additional durability of key outcomes. As with our previous report, this study received a waiver of authorization for the use and disclosure of protected health information (PHI) and a determination of exempt status under 45 CFR § 46.104(d)(4) from Western Institutional Review Board on 2 April 2020. IP and ED utilization remained relatively low during months 6 to 9 following reSET-O initiation, with 18 IP stays and 79 ED visits during this period (versus 32 IP stays and 97 ED visits in months 3–6), continuing the trend of reduced quarterly utilization of these services observed during the first 6 months after reSET-O treatment initiation. Consistent with our prior analysis, the period 9-months following reSET-O prescription showed a significant decrease in IP stays (66 fewer – 50% decrease) and ED visits (91 fewer – 27%) versus the 9 months prior to prescription of the product. We also observed decreases in the use of a variety of high-cost clinical services 9 months after reSET-O initiation, including inpatient observation visits, physical medicine/rehabilitation, cardiovascular procedures, inpatient detoxification for alcohol and substance use disorders, and surgery. In addition to reducing IP and ED visits, we observed multiple reductions in healthcare utilization suggesting a stabilization of patient outcomes. A further reduction in the quarterly trend of drug testing and additional substitution of individual and group counseling sessions was observed during months 6–9 (drug tests: 1,905; counseling sessions: 1,309) compared to the quarterly average during the first 6 months after reSET-O treatment initiation (drug tests: 2,028; counseling sessions: 1,373), and the 6 months prior to reSET-O initiation (drug tests: 2,192; counseling sessions: 1,421). Compared to our previous analysis, we observed a slight reduction in the quarterly trend of case management, behavioral health, and mental health rehabilitative services consultations (months 6–9: case management: 1,544; mental