L\u2019\u00e9tude porte sur l\u2019\u00e9volution de la d\u00e9livrance de traitements m\u00e9dicamenteux pour le trouble li\u00e9 \u00e0 l\u2019usage d\u2019opio\u00efdes (MOUD), en particulier la m\u00e9thadone et la bupr\u00e9norphine, aux \u00c9tats\u2011Unis entre 2019 et 2024, dans un contexte o\u00f9 les d\u00e9c\u00e8s par surdose restent \u00e9lev\u00e9s malgr\u00e9 l\u2019existence de traitements efficaces. Elle s\u2019int\u00e9resse aux assur\u00e9s diagnostiqu\u00e9s pour trouble li\u00e9 \u00e0 l\u2019usage d\u2019opio\u00efdes couverts par des r\u00e9gimes d\u2019assurance maladie priv\u00e9s commerciaux ou par Medicare Advantage (MA). Deux \u00e9volutions de politique f\u00e9d\u00e9rale sont mentionn\u00e9es : \u00e0 partir de 2020, Medicare a commenc\u00e9 \u00e0 rembourser la m\u00e9thadone pour le traitement de ce trouble, et des assouplissements r\u00e9glementaires ont parall\u00e8lement \u00e9largi l\u2019acc\u00e8s aux MOUD par t\u00e9l\u00e9m\u00e9decine dans le contexte de la pand\u00e9mie de COVID\u201119.<\/p>\n
Les auteurs ont men\u00e9 une \u00e9tude r\u00e9trospective, r\u00e9p\u00e9t\u00e9e de fa\u00e7on transversale par trimestre, \u00e0 partir de la base de donn\u00e9es Clinformatics\u00ae Data Mart (Optum, donn\u00e9es pseudonymis\u00e9es) couvrant la p\u00e9riode 2019\u20112024. Ils ont calcul\u00e9, par trimestre, les taux de d\u00e9livrance de m\u00e9thadone et de bupr\u00e9norphine pour 100 000 assur\u00e9s ayant un diagnostic de trouble li\u00e9 \u00e0 l\u2019usage d\u2019opio\u00efdes, en distinguant le type de couverture (assurance commerciale vs Medicare Advantage), l\u2019\u00e2ge et le statut de double \u00e9ligibilit\u00e9 (b\u00e9n\u00e9ficiaires \u00e0 la fois de Medicare et de Medicaid). Une analyse de r\u00e9gression par \u00ab joinpoint \u00bb a permis d\u2019identifier les points d\u2019inflexion statistiquement significatifs des tendances et les variations annuelles en pourcentage.<\/p>\n
Entre le premier trimestre 2020 et le deuxi\u00e8me trimestre 2024, chez les assur\u00e9s Medicare Advantage diagnostiqu\u00e9s, le taux de d\u00e9livrance de m\u00e9thadone est pass\u00e9 de 624 \u00e0 5 462 pour 100 000, soit une augmentation moyenne annuelle de 104,6 %. Sur la m\u00eame p\u00e9riode, le taux correspondant pour les assur\u00e9s commerciaux est pass\u00e9 de 3 552 \u00e0 6 821 pour 100 000, soit une hausse moyenne annuelle de 23,9 %. Pour la bupr\u00e9norphine, les taux de d\u00e9livrance chez les assur\u00e9s Medicare Advantage ont augment\u00e9 de mani\u00e8re r\u00e9guli\u00e8re avec une progression moyenne annuelle de 20,7 %. En revanche, chez les assur\u00e9s commerciaux, les taux de d\u00e9livrance de bupr\u00e9norphine ont atteint un pic en 2022 puis ont diminu\u00e9 apr\u00e8s le deuxi\u00e8me trimestre 2023, \u00e0 un rythme moyen de \u201320,0 % par an. Les assur\u00e9s Medicare Advantage en situation de double \u00e9ligibilit\u00e9 et \u00e2g\u00e9s de moins de 65 ans pr\u00e9sentaient les taux de d\u00e9livrance de MOUD les plus \u00e9lev\u00e9s sur l\u2019ensemble de la p\u00e9riode.<\/p>\n
Les principaux enjeux de politique publique mis en \u00e9vidence concernent les diff\u00e9rences de trajectoire entre r\u00e9gimes d\u2019assurance et cat\u00e9gories de b\u00e9n\u00e9ficiaires. L\u2019augmentation marqu\u00e9e de la d\u00e9livrance de m\u00e9thadone chez les b\u00e9n\u00e9ficiaires de Medicare Advantage apr\u00e8s l\u2019extension de la couverture en 2020, en particulier chez les personnes en double \u00e9ligibilit\u00e9 de moins de 65 ans, sugg\u00e8re un effet important des changements de prise en charge sur l\u2019acc\u00e8s au traitement. \u00c0 l\u2019inverse, la baisse observ\u00e9e de la d\u00e9livrance de bupr\u00e9norphine dans le secteur commercial apr\u00e8s 2022 appelle des analyses compl\u00e9mentaires pour en comprendre les causes. Les auteurs soulignent qu\u2019il pourrait \u00eatre n\u00e9cessaire de mettre en place des actions cibl\u00e9es afin de r\u00e9duire les \u00e9carts de traitement li\u00e9s au type de payeur et de soutenir un acc\u00e8s plus large aux MOUD. L\u2019\u00e9tude met ainsi en avant des dynamiques diff\u00e9renci\u00e9es entre assurance priv\u00e9e commerciale et Medicare Advantage, susceptibles d\u2019int\u00e9resser les administrations fran\u00e7aises pour le suivi international des politiques d\u2019acc\u00e8s aux traitements des troubles li\u00e9s \u00e0 l\u2019usage d\u2019opio\u00efdes.(contenu r\u00e9sum\u00e9 en fran\u00e7ais par l’IA)\u00a0Lire la Suite<\/a><\/p>","protected":false},"excerpt":{"rendered":" L\u2019\u00e9tude porte sur l\u2019\u00e9volution de la d\u00e9livrance de traitements m\u00e9dicamenteux pour le trouble li\u00e9 \u00e0 l\u2019usage d\u2019opio\u00efdes (MOUD), en particulier la m\u00e9thadone et la bupr\u00e9norphine, aux \u00c9tats\u2011Unis entre 2019 et 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