Economic burden and dosing trends of buprenorphine buccal film and transdermal patch in chronic low back pain

Abstract

Aim: Exploring prescribing trends and economic burden of chronic low back pain (cLBP) patients prescribed buprenorphine buccal film (Belbuca®) or transdermal patches. Methods: In the MarketScan® commercial insurance claims (employees and their spouses/dependents, 2018–2021), the first film or patch prescription date was an index event. The observation covered 6-month pre-index and 12-month post-index periods. Results: Patients were propensity-score matched (708 per cohort). Buprenorphine initiation had stable cost trends in buccal film and increasing trends in transdermal patch cohort. Between-cohort comparisons of healthcare expenditures, cost trends and resource utilization showed significant differences, mostly in favor of buccal film. Buccal film also had higher daily doses and wider dosing range. Conclusion: Buprenorphine film is more cost-effective cLBP treatment with more flexible dosing.

Plain language summary

What is this article about?

This retrospective study included patients with chronic low back pain (cLBP) and commercial insurance in the USA. Only patients treated with Belbuca®, a buprenorphine buccal film, or a buprenorphine transdermal patch were included. Patients were observed 6 months prior to and 12 months after the first buprenorphine prescription. Healthcare costs, cost trends, resource use and buprenorphine treatment characteristics were explored.

What were the results?

Patients with cLBP on buccal film had lower costs, stable cost trends and less healthcare resources used. Also, they had higher buprenorphine daily doses.

What do the results mean?

The results imply that buccal film is less costly for cLBP patients than patches. The buccal film had more flexible dosing with higher daily doses, which might be associated with better pain control.

Article highlights

• This retrospective commercial claims study analyzed US patients diagnosed with chronic low back pain (cLBP) and prescribed buprenorphine buccal film or buprenorphine transdermal patches.

• Index date was the first buprenorphine prescription claim with an observation of 6 months pre-index and 12 months post-index periods and a propensity-score matching analysis based on the population characteristics (708 per cohort).

• The analysis of healthcare cost trends (6-months pre-index vs. 6-months post-index) showed stable expenditures after buccal film initiation with a $56 saving in cLBP-related ED costs (p = 0.025).

• Introduction of buprenorphine patch led to increasing trends in total all-cause and cLBP-related healthcare costs ($3989 [p < 0.001] and $1337 [p = 0.043], respectively), driven by cost increase in the outpatient setting ($1734; p < 0.001).

• The significant between-group differences were reported in all-cause outpatient cost changes ($438 saving in buccal film vs. $1734 increase in a transdermal patch; p = 0.011) and cLBP-related total cost changes ($626 saving in buccal film vs. $1337 increase in a transdermal patch; p = 0.033).

• During the 6-month follow-up, the buccal film was associated with lower cLBP-related ED ($29 vs. $73 [p = 0.038], respectively) and total cLBP-related costs ($2909 vs. $4124 [p = 0.047], respectively).

• Buprenorphine film patients had lower cLBP-related healthcare costs and resource utilization measures in the ED setting over the 12-month follow-up.

• The difference in pre-index outpatient costs ($7979 buccal film vs. $6332 transdermal patch; p = 0.027) diminished during the follow-up.

• Although there were no differences in buprenorphine prescription counts and treatment duration, buccal film patients had a much higher average buprenorphine daily dose than transdermal patch patients (502.0 vs. 236.7 mcg; p < 0.001).

• Monthly analysis also showed a wider distribution of buccal film patients across different average buprenorphine daily dose categories (<100 to ≥2000 mcg groups) compared with a narrower dosing range in transdermal patch patients (100–800 mcg).

Keywords: :

• buprenorphine buccal film
• buprenorphine dose
• buprenorphine transdermal patch
• chronic pain management
• economic trends
• healthcare expenditures
• insurance claims
• real-world evidence
• resource consumption
• schedule III opioid

Supplemental materials

Supplemental data for this article can be accessed at https://doi.org/10.1080/17581869.2024.2348989

Acknowledgments

All steps in conducting this research were supervised and critically reviewed by experts from Collegium Pharmaceutical, Inc.

Author contributions

V Zah, F Stanicic, D Vukicevic and D Grbic equally contributed to this research. All authors were responsible for the conception and design of the work, the acquisition, analysis and interpretation of data for the work, drafting the work and revising it critically for important intellectual content, providing the final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Financial disclosure

This study was funded by Collegium Pharmaceutical, Inc. ZRx Outcomes Research Inc. received financial support for conducting the research. V Zah, F Stanicic, D Vukicevic and D Grbic are employees of ZRx Outcomes Research Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was funded for manuscript preparation.

Additional information

Funding

This study was funded by Collegium Pharmaceutical, Inc. ZRx Outcomes Research Inc. received financial support for conducting the research. V Zah, F Stanicic, D Vukicevic and D Grbic are employees of ZRx Outcomes Research Inc.