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McGee M, Chiu K, Moineddin R, Sud A. The Impact of Suboxone's Market Exclusivity on Cost of Opioid Use Disorder Treatment. Appl Health Econ Health Policy 2023; 21:501-510. [PMID: 36652186 PMCID: PMC10119248 DOI: 10.1007/s40258-022-00787-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Buprenorphine-naloxone is an essential part of the response to opioid poisoning rates in North America. Manipulating market exclusivity is a strategy manufacturers use to increase profitability, as evidenced by Suboxone in the USA. OBJECTIVE To investigate excess costs of buprenorphine-naloxone due to unmerited market exclusivity (no legal patent or data protection) in Canada. METHODS Using controlled interrupted time-series, this study examined changes in the cost of buprenorphine-naloxone before and after the first generics were listed on public formularies. Methadone cost was the control. Public data from the Canadian Institute of Health Information in British Columbia, Manitoba, and Saskatchewan were used. All buprenorphine-naloxone and methadone claims (2010-2019) accepted for payment by the provincial drug plan/programme were collected. Primary outcome was mean cost per mg of buprenorphine-naloxone after the first listing of generics. RESULTS Mean cost per mg of buprenorphine-naloxone before the first listing of generics was $1.21 CAD in British Columbia, $1.27 CAD in Manitoba, and $0.85 CAD in Saskatchewan. Following the introduction of generics, the cost per mg decreased by $0.22 CAD (95% CI - 0.33 to - 0.10; p = 0.0014) in British Columbia, $0.36 CAD (95% CI - 0.58 to - 0.13; p = 0.004) in Manitoba, and $0.27 CAD (95% CI - 0.50 to - 0.05; p = 0.03) in Saskatchewan. Mean cost per mg decreased by $0.26 CAD (95% CI - 0.38 to - 0.13; p = 0.0004) after a third generic was introduced in British Columbia. Excess costs to public formularies during the 4- to 5-year period prior to the listing of generics were $1,992,558 CAD in British Columbia, $80,876 CAD in Manitoba, and $4130 CAD in Saskatchewan. If buprenorphine-naloxone cost $0.61 CAD (mean cost after the third generic entered) instead of $1.21 CAD per mg during the pre-generics period, public payers in British Columbia could have saved $5,016,220 CAD between 2011 and 2015. CONCLUSIONS Unmerited 6 years of market exclusivity for brand-name buprenorphine-naloxone in Canada resulted in substantial excess costs. There is an urgent need to implement policies that can help reduce costs for high-priority drugs in Canada.
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Affiliation(s)
- Meghan McGee
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
| | - Kellia Chiu
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abhimanyu Sud
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Humber River Hospital, Toronto, ON, Canada.
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Barenie RE, Sinha MS, Kesselheim AS. Factors Affecting Buprenorphine Utilization and Spending in Medicaid, 2002-2018. Value Health 2021; 24:182-187. [PMID: 33518024 DOI: 10.1016/j.jval.2020.04.1840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Buprenorphine is an essential medication for the treatment of opioid use disorder (OUD), but studies show it has been underused over the last 2 decades. We sought to evaluate utilization of and spending on buprenorphine formulations in Medicaid and to evaluate the impact of key market and regulatory factors affecting availability of different formulations and generic versions. METHODS We first identified all buprenorphine formulations approved by the Food and Drug Administration for OUD using Drugs@FDA. We then used National Drug Codes to identify each drug in the Medicaid State Drug Utilization Data and extracted annual utilization rates and spending between 2002 and 2018 by drug and according to whether a brand-name or generic version was dispensed. We compared these trends to market and regulatory factors that affected competition, which we identified through searching the Federal Register, Westlaw, PubMed, and Google News. RESULTS Brand-name buprenorphine-naloxone sublingual tablet and film formulations (Suboxone) were dispensed 2.7 times more (n = 634 213 140) and reimbursed 4.4 times more (n = $4 440 556 473) than all other formulations combined (n = 237 769 689; $1 018 988 133). We identified numerous market and regulatory factors that contributed to an estimated 9-year delay in generic versions of the tablet formulation and 6-year delay for generic versions of the film formulation. CONCLUSIONS Brand-name buprenorphine formulations have been widely used in Medicaid, leading to substantial costs, in part because generic versions were delayed by multiple years owing to market and regulatory factors. Timely availability of low-cost generics could have helped encourage OUD treatment with buprenorphine during the height of the opioid crisis.
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Affiliation(s)
- Rachel E Barenie
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Michael S Sinha
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, MA, USA
| | - Aaron S Kesselheim
- Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Roe M, Wilson CG, Fusco CW, Hulkower S, Stigleman S. Does XR injectable naltrexone prevent relapse as effectively as daily sublingual buprenorphine-naloxone? J Fam Pract 2020; 69:E14-E15. [PMID: 33348352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
YES. MONTHLY EXTENDED-RELEASE INJECTABLE NALTREXONE (XR-NTX) TREATS OPIOID USE DISORDER AS EFFECTIVELY AS DAILY SUBLINGUAL BUPRENORPHINE-NALOXONE (BUP-NX) WITHOUT CAUSING ANY INCREASE IN SERIOUS ADVERSE EVENTS OR FATAL OVERDOSES. (STRENGTH OF RECOMMENDATION: A, 2 GOOD-QUALITY RCTS).
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Affiliation(s)
- Matthew Roe
- Mountain Area Health Education Center (MAHEC), Asheville, NC, USA
| | - Courtenay Gilmore Wilson
- Eshelman School of Pharmacy, University of North Carolina Health Sciences at MAHEC, Asheville, USA
| | | | - Stephen Hulkower
- University of North Carolina Health Sciences at MAHEC, Asheville, USA
| | - Sue Stigleman
- University of North Carolina Health Sciences at MAHEC, Asheville, USA
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Affiliation(s)
- Rebecca L Haffajee
- From the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor (R.L.H.); and RAND (R.L.H.) and the Department of Health Care Policy, Harvard Medical School (R.G.F.) - both in Boston
| | - Richard G Frank
- From the Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor (R.L.H.); and RAND (R.L.H.) and the Department of Health Care Policy, Harvard Medical School (R.G.F.) - both in Boston
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Abstract
Despite some improvements in access to evidence-based medications for opioid use disorder, treatment rates remain low at under a quarter of those with need. High costs for brand name products in these medication markets have limited the volume of drugs purchased, particularly through public health insurance and grant programs. Brand firm anti-competitive practices around the leading buprenorphine product Suboxone - including product hops, citizen petitions and Risk Evaluation and Mitigation Strategy abuses - helped to maintain high prices by extending brand exclusivity periods and hindering generic drug entry. Remedies to address costly anti-competitive activities include adoption of the proposed CREATES Act and modernization of the Hatch-Waxman Act by the Congress, and implementation of substantive modifications to the Food and Drug Administration citizen petition filing procedures. Given the persistence of these abuses, prescriptive changes are favorable to the procedural and clarifying steps thus far favored by the federal government. Extrapolating from the 37% price declines attributable to generic entry for buprenorphine tablets in 2011, our calculations suggest that implementing these remedies to facilitate generic competition with Suboxone film would have resulted in savings of approximately $703 million overall and $203 million to Medicaid in 2017.
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Affiliation(s)
- Rebecca L Haffajee
- Rebecca L. Haffajee, J.D., Ph.D., M.P.H., is a Policy Researcher at RAND Corporation and an Adjunct Assistant Professor in the Department of Health Management and Policy at the University of Michigan. She received her J.D. from Harvard Law School, Cambridge, Massachusetts, and her M.P.H. from the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, both in 2006. She received her Ph.D. in Health Policy (in evaluative sciences and statistics) from Harvard University, Cambridge, Massachusetts in 2016. Her research is focused in the behavioral health and pharmaceutical policy areas, evaluating policies such as mental health/substance use parity and laws intended to curb opioid addiction and misuse. Richard G. Frank, Ph.D., is the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School. From 2009 to 2011, he served as the deputy assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services (DHHS), directing the office of Disability, Aging and Long-Term Care Policy. From 2013 to 2014, he served as a Special Advisor to the Office of the Secretary at the DHHS, and from 2014 to 2016 he served as Assistant Secretary for Planning and Evaluation in the DHHS. His research is focused on the economics of mental health and substance abuse care, long-term care financing policy, health care competition, implementation of health reform and disability policy
| | - Richard G Frank
- Rebecca L. Haffajee, J.D., Ph.D., M.P.H., is a Policy Researcher at RAND Corporation and an Adjunct Assistant Professor in the Department of Health Management and Policy at the University of Michigan. She received her J.D. from Harvard Law School, Cambridge, Massachusetts, and her M.P.H. from the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, both in 2006. She received her Ph.D. in Health Policy (in evaluative sciences and statistics) from Harvard University, Cambridge, Massachusetts in 2016. Her research is focused in the behavioral health and pharmaceutical policy areas, evaluating policies such as mental health/substance use parity and laws intended to curb opioid addiction and misuse. Richard G. Frank, Ph.D., is the Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School. From 2009 to 2011, he served as the deputy assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services (DHHS), directing the office of Disability, Aging and Long-Term Care Policy. From 2013 to 2014, he served as a Special Advisor to the Office of the Secretary at the DHHS, and from 2014 to 2016 he served as Assistant Secretary for Planning and Evaluation in the DHHS. His research is focused on the economics of mental health and substance abuse care, long-term care financing policy, health care competition, implementation of health reform and disability policy
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Barocas JA, Morgan JR, Fiellin DA, Schackman BR, Eftekhari Yazdi G, Stein MD, Freedberg KA, Linas BP. Cost-effectiveness of integrating buprenorphine-naloxone treatment for opioid use disorder into clinical care for persons with HIV/hepatitis C co-infection who inject opioids. Int J Drug Policy 2019; 72:160-168. [PMID: 31085063 PMCID: PMC6717527 DOI: 10.1016/j.drugpo.2019.05.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Untreated opioid use disorder (OUD) affects the care of HIV/HCV co-infected people who inject opioids. Despite active injection opioid use, there is evidence of increasing engagement in HIV care and adherence to HIV medications among HIV/HCV co-infected persons. However, less than one-half of this population is offered HCV treatment onsite. Treatment for OUD is also rare and largely occurs offsite. Integrating buprenorphine-naloxone (BUP-NX) into onsite care for HIV/HCV co-infected persons may improve outcomes, but the clinical impact and costs are unknown. We evaluated the clinical impact, costs, and cost-effectiveness of integrating (BUP-NX) into onsite HIV/HCV treatment compared with the status quo of offsite referral for medications for OUD. METHODS We used a Monte Carlo microsimulation of HCV to compare two strategies for people who inject opioids: 1) standard HIV care with onsite HCV treatment and referral to offsite OUD care (status quo) and 2) standard HIV care with onsite HCV and BUP-NX treatment (integrated care). Both strategies assume that all individuals are already in HIV care. Data from national databases, clinical trials, and cohorts informed model inputs. Outcomes included mortality, HCV reinfection, quality-adjusted life years (QALYs), costs (2017 US dollars), and incremental cost-effectiveness ratios. RESULTS Integrated care reduced HCV reinfections by 7%, cases of cirrhosis by 1%, and liver-related deaths by 3%. Compared to the status quo, this strategy also resulted in an estimated 11/1,000 fewer non-liver attributable deaths at one year and 28/1,000 fewer of these deaths at five years, at a cost-effectiveness ratio of $57,100/QALY. Integrated care remained cost-effective in sensitivity analyses that varied the proportion of the population actively injecting opioids, availability of BUP-NX, and quality of life weights. CONCLUSIONS Integrating BUP-NX for OUD into treatment for HIV/HCV co-infected adults who inject opioids increases life expectancy and is cost-effective at a $100,000/QALY threshold.
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Affiliation(s)
- Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA; Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA.
| | - Jake R Morgan
- Boston University School of Public Health, Department of Health Law, Policy and Management, 715 Albany Street, T3-West, Boston, MA, 02118-2526, USA
| | - David A Fiellin
- Yale Schools of Medicine and Public Health, Yale Center for Interdisciplinary Research on AIDS, PO Box 208056, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Bruce R Schackman
- Weill Cornell Medicine, Department of Healthcare Policy & Research, 425 East 61st Street, Suite 301, New York, NY, 10065-8722, USA
| | - Golnaz Eftekhari Yazdi
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
| | - Michael D Stein
- Boston University School of Public Health, Department of Health Law, Policy and Management, 715 Albany Street, T3-West, Boston, MA, 02118-2526, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center and Divisions of General Internal Medicine and Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, 100 Cambridge St, 16th Floor, Boston, MA, 02114, USA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 100 Cambridge St, 16th Floor, Boston, MA, 02114, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center (BMC), 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA; Boston University School of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA, 02118, USA
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McCollister KE, Leff JA, Yang X, Lee JD, Nunes EV, Novo P, Rotrosen J, Schackman BR, Murphy SM. Cost of pharmacotherapy for opioid use disorders following inpatient detoxification. Am J Manag Care 2018; 24:526-531. [PMID: 30452209 PMCID: PMC6345513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To estimate the costs of providing extended-release injectable naltrexone (XR-NTX) and buprenorphine-naloxone (BUP-NX) following inpatient detoxification using data derived from a multisite randomized controlled trial at 8 US community-based treatment programs. STUDY DESIGN Cost data were collected for 3 intervention phases: program start-up, inpatient detoxification, and up to 24 weeks of medication induction and management visits (post detoxification). Cost analyses were from the healthcare sector perspective (2015 US$); patient costs are also reported. METHODS We conducted site visits, administered a cost survey to treatment programs, and analyzed study data on medication and services utilization. Nationally representative sources were used to estimate unit costs. Uncertainty was evaluated in sensitivity analyses. RESULTS Mean start-up costs were $1071 per program for XR-NTX and $828 per program for BUP-NX. Mean costs per participant were $5416 for XR-NTX (57% detoxification, 37% medication, 3% provider, 3% patient) and $4148 for BUP-NX (64% detoxification, 12% medication, 10% provider, 14% patient). Total cost per participant ranged by site from $2979 to $8963 for XR-NTX and from $2521 to $6486 for BUP-NX. CONCLUSIONS For treatment providers, offering XR-NTX and/or BUP-NX as part of existing detoxification treatment modalities generates modest costs in addition to the costs of detoxification, which vary substantially among the 8 sites. From the patient's perspective, the costs associated with medication management visits may be a barrier for some individuals considering these treatments.
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Affiliation(s)
- Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Soffer Clinical Research Center, Ste 1019, 1120 NW 14th St, Miami, FL 33136.
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Soper R, Appajosyula S, Deximo C. Decline in Buprenorphine/Naloxone Prescriptions in a State Medicaid Population Following Formulary Conversion from Suboxone to Bunavail. Adv Ther 2018; 35:457-466. [PMID: 29623562 DOI: 10.1007/s12325-018-0696-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A large, statewide, fee-for-service Medicaid plan recently (October 2015) executed a complete switch from sublingual buprenorphine-naloxone [(SLBN), Suboxone®] to buccal buprenorphine-naloxone [(BBN), Bunavail®] on its preferred drug formulary. This complete formulary switch provided an opportunity to assess dynamic changes in prescribing patterns, patient/physician acceptance, and indices of potential misuse/diversion. METHODS For the period January 1, 2015 through December 31, 2016, two datasets were analyzed: prescriptions and associated costs for buprenorphine-naloxone (BN) products and urine toxicology test results for patients in the Medicaid plan. The dataset comprised 1370 unique providers ordering 643,225 prescriptions for opioid addiction therapy. Patient and order volumes, and the rate of monthly positive laboratory values for opioid molecules and cocaine were reviewed. A targeted survey of physicians treating opioid-dependent patients with state Medicaid plan coverage was also conducted. RESULTS Upon plan conversion to BBN, there was a rapid increase in monthly BBN prescriptions mirrored by a rapid decrease in SLBN prescriptions. Peak in BBN prescriptions (2633 in November 2015) was approximately 60% lower than peak in SLBN prescriptions (6531 in July 2015). An unexpected finding was a 68% reduction of the overall BN market, indicating that many BN prescriptions were abandoned. The reduction was associated with quarterly cost savings to the Medicaid plan of approximately $3.5 million. Toxicology results indicated a reduction in drug positivity (defined as positivity for cocaine and/or any opioids except buprenorphine and methadone) from 13-16% in 2015 to less than 10% in 2016. Heroin positivity decreased from approximately 9% in December 2015 to an average of less than 1% during the last quarter of 2016, while positivity for norbuprenorphine, the major metabolite of buprenorphine, showed a marked increase in 2016 vs 2015. Among physicians who responded to the targeted survey most rated BBN as more difficult to abuse or misuse than SLBN. CONCLUSION The rapid reduction in the overall BN market following a complete formulary switch from SLBN to BBN was associated with quarterly savings of $3.5 million for the state Medicaid plan. Toxicology data suggest that this cost saving was realized in the context of improved physician and patient adherence to treatment protocols. The changing market dynamics can potentially be explained by a number of contributory factors, including a reduction of diversion and illicit distribution of BN following formulary conversion. These results are considered hypothesis-generating and future research should systematically compare the propensity for diversion and abuse of BN products using various epidemiological tracking tools. FUNDING BioDelivery Sciences International, Inc.
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PROVIDER AGREEMENTS WITH HEALTH PLANS AND SEPARATE TAX IDS. Tenn Med 2016; 109:13. [PMID: 29718605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Asche CV, Clay E, Kharitonova E, Zah V, Ruby J, Aballéa S. Budgetary impact of the utilization of buprenorphine/naloxone sublingual film and tablet for Medicaid in the United States. J Med Econ 2015; 18:600-11. [PMID: 25851505 DOI: 10.3111/13696998.2015.1036760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The buprenorphine/naloxone combination for the treatment of opioid dependence is available in a film or tablet formulation. Recent retrospective studies demonstrated that treatment with the sublingual film formulation is associated with improved treatment retention and lower healthcare costs. In March 2013, generic buprenorphine/naloxone tablets were approved in the US. A budget impact model was built to compare healthcare expenditures for different market shares of sublingual film and tablet. METHODS A Markov model was developed to track a cohort of opioid dependent patients treated with sublingual film or tablet through the following treatment phases: initiation, maintenance, discontinuation, off-treatment and reinitiation. Transition probabilities and costs for each phase were estimated from the MarketScan Medicaid database for the period between 1 March 2010 and 30 June 2012. The total expenditure for the plan and expenditure per plan member per month were predicted over 5 years. Two market share scenarios were considered: 1) sublingual film is progressively replaced by generic tablet (current situation) and 2) the sublingual film holds a market share of 100%. RESULTS Predicted total costs over 5 years were $6400 million when the sublingual film holds a market share of 100% (as per Scenario 2) which is lower than when sublingual film is progressively replaced by generic tablet (current situation as per Scenario 1) by $64 million. These savings were mostly driven by inpatient care ($56 million saved over 5 years), followed by emergency room care ($27 million) and pharmaceutical costs ($24 million). Costs of outpatient care attenuated the difference as they were predicted to be higher by $44 million in Scenario 2. The reduction in total cost per member per month reached $0.027 in the fifth year. Results were most sensitive to price rebates and to the probability of non-psychiatric hospitalization. CONCLUSIONS While using the sublingual film formulation for more patients treated with buprenorphine/naloxone is predicted to increase outpatient care costs, it would generate savings in emergency care and hospitalizations. In the treatment of opioid dependence, total direct medical costs for Medicaid would be lower for sublingual film treated patients, at current drug prices.
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Affiliation(s)
- Carl V Asche
- a a University of Illinois College of Medicine at Peoria/University of Illinois at Chicago College of Pharmacy , Peoria , IL , USA
| | | | | | - Vladimir Zah
- d d ZRx Outcomes Research Inc. , Mississauga , ON , Canada
| | - Jane Ruby
- e e Reckitt Benckiser Pharmaceuticals Inc. , Richmond , VA , USA
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