Budgetary impact of the utilization of buprenorphine/naloxone sublingual film and tablet for Medicaid in the United States

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.

Keywords::

• Buprenorphine/naloxone
• Budget impact model
• Healthcare expenditures
• Medicaid

Transparency

Declaration of funding

This study was funded by Reckitt Benckiser Pharmaceuticals (RBP).

All authors contributed to the design, writing and final approval of this manuscript. S.A., E.C., E.K., and V.Z. conducted data collection and analysis and interpretation of the results. S.A., E.C. and E.K. received funding from ZRx. C.V.A. received no funding.

Declaration of financial/other relationships

V.Z. has disclosed that he is a health economist with ZRx Outcomes, Toronto, Canada. C.V.A. has disclosed that he is a health economist at the University of Illinois. S.A., E.C., and E.K. have disclosed that they are health economists for Creativ-Ceutical Chicago and Paris. J.R. has disclosed that she is an employee of Reckitt Benckiser Pharmaceuticals. V.Z. and C.V.A. have disclosed that they have received honoraria from RBP. Creativ-Ceuticals and University of Illinois have no financial relationship with RBP.

Reckitt Benckiser Pharmaceuticals, Inc. via Creativ-Ceutical funded the study described in this manuscript. Carl Asche was paid as a consultant as were Vladimir Zah, Emile Clay, Elizaveta Kharitonova, and Samuel Aballéa. Jane Ruby is an employee of Reckitt Benckiser Pharmaceuticals, Inc.

Acknowledgments

Reckitt Benckiser Pharmaceuticals, Inc. funded the study described in this manuscript.

Notes

*Suboxone is a registered trademark of Reckitt Benckiser Pharmaceuticals, Inc., a subsidiary of Indivior, PLC. Richmond, VA, USA.