{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T01:56:05Z","timestamp":1791251765189,"version":"4.1.0"},"reference-count":41,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2015,7,14]],"date-time":"2015-07-14T00:00:00Z","timestamp":1436832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>In pharmacoepidemiology, one of the main concerns is analysis of drug exposure time. However, in real\u2010life settings, patient's behavior is complex and characterized by drug exposure dynamics. Multi\u2010state models allow assessing the probabilities of various patterns, instead of just continuous use and\/or discontinuation. The aim of this study was to illustrate with methadone, the use of multi\u2010state model (MSM) in a large claims database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study is based on the French health insurance reimbursement database. Methadone exposure is defined using four states for each period of follow\u2010up: syrup only, capsule only, syrup\u2010capsule and no dispensing. The model considered 12 possible transitions (including reverse transitions) from one state to another. To describe these transitions a time\u2010homogeneous Markov model was used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1265 methadone users were included. When patients belonged to the syrup\u2010capsule state, they had a 61.8% chance of moving to capsules the following month and 20.9% of moving to syrup. The probability of moving from the syrup to the non\u2010user state was 13.6% (11.7% from capsule state to non\u2010user state). The average length of stay was 5.9\u2009months (CI95%: [5.5\u20136.4]) in capsule state, 4.9 (CI95%: [4.6\u20135.2]) in syrup state and 5.9 (CI95%: [5.5\u20136.3]) in non user state.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>MSM provided a good description of methadone patterns of use. It outlined behaviors which have led to a rapid spread of capsule formulation among methadone users. Therefore, it illustrates the utility of MSM for modeling multiple sequences of drug use in a large claims database. Copyright \u00a9 2015 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.3835","type":"journal-article","created":{"date-parts":[[2015,7,14]],"date-time":"2015-07-14T23:24:35Z","timestamp":1436916275000},"page":"991-998","source":"Crossref","is-referenced-by-count":6,"title":["Use of a multi\u2010state model in a claims database: illustration with methadone"],"prefix":"10.1002","volume":"24","author":[{"given":"Quentin","family":"Boucherie","sequence":"first","affiliation":[{"name":"Aix Marseille Universit\u00e9, Institut de Neurosciences Timone CNRS 7289, Service de Pharmacologie clinique et pharmacovigilance\u2014  264, rue Saint Pierre 13385 Marseille France"},{"name":"Centre d'addictovigilance (CEIP) PACA\u2010Corse Marseille  264, rue Saint Pierre 13385 Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Pauly","sequence":"additional","affiliation":[{"name":"Aix Marseille Universit\u00e9, EA 3279 Laboratoire de 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