Five-year budget impact of a prescription digital therapeutic for patients with opioid use disorder

Figures & data

Figure 1. Budget impact model structure.

Key: OUD – opioid use disorder; TAU – treatment-as-usual.

Table 1. Plan and market assumptions for base-case model

Parameter	Value	Source
Plan size	1 million	Baseline assumption
Population aged 18‒64 years	69.80%	[28]
Patients with OUD	0.15%	[28]
Had an outpatient visit	36.10%	[28]
Treated with buprenorphine	28.50%	[28]
Population aged ≥65 years	7.30%	[28]
Patients with OUD	0.03%	[28]
Had an outpatient visit	56.20%	[28]
Treated with buprenorphine	10.40%	[28]
Current market shares
reSET-O + TAU	0.00%	Baseline assumption
TAU only	18.1%	[30]
No treatment	81.9%	[30]
Annual market share expansion of reSET-O	1.50%	Baseline assumption

Key: OUD – opioid use disorder; TAU – treatment-as-usual.

Table 2. Treatment costs for reSET-O + TAU and TAU only groups

	reSET-O + TAU		TAU only
Variables	Value	Source/notes	Value	Source/notes
Per-patient treatment costs
CBT+CM	$1,440	Accounting for 5% discounts off WAC plus 8.5% reimbursement for nonengaging patients on the WAC cost of $1,665	$435	Sum of CBT and CM costs
CBT	N/A	Costs of CBT and CM are already included in the reSET-O cost	$71	[34]
CM	N/A		$364	[35]
Patient cost-share	$55	Average cost-share amount at tier 3 for 4-tier copay designs, rounded to the nearest $5 [31]	$0	N/A
Buprenorphine	$419	[34]	$419	[34]
Patient cost-share	$10	Average cost-share amount at tier 1 for 4-tier copay designs, rounded to the nearest $5 [31]	$10	Average cost-share amount at tier 1 for 4-tier copay designs, rounded to the nearest $5 [31]
Counseling session	$276	[31, 40, 44]	$552	[31, 40]
Units	3	[42]	6	[42]
Unit cost	$92	[44]	$92	[44]
Urinalysis	$864	Unit cost multiplied by the number of units	$864	Unit cost multiplied by the number of units
Units	12	[49]	12	[49]
Unit cost	$72	[44]	$72	[44]
Total per-patient costs (year 1)
Average annual number of treatments with reSET-O	1.2	Derived from claims analysis: data on file, Pear Therapeutics, Inc.	0	N/A
Average annual number of 12-week sessions (TAU)	1.035	Real-world claims data analysis, post-reSET-O initiation [62]	1.68	Real-world claims data analysis, prior to reSET-O initiation [62]
Calculated average total treatment costs per patient	$3,265	Calculated by multiplying per-patient annual treatment costs and treatment sessions	$4,520	Calculated by multiplying per-patient annual treatment costs and treatment sessions
Total per-patient costs (years 2–5)
% receiving subsequent annual therapy (reSET-O)	6.40%	Assumption	N/A	N/A
% receiving subsequent annual therapy (TAU)	71.25%	Extrapolation from clinical trial efficacy on top of 57% for TAU	57%	This is the same reference for 57% median retention at 1 year mentioned in the Introduction
Calculated average total treatment costs per patient	$1,431	Calculated by multiplying first-year treatment costs and percentage continued treatment	$2,576	Calculated by multiplying first-year treatment costs and percentage continued treatment

Key: CBT – cognitive behavioral therapy; CM – contingency management; N/A – not applicable; TAU – treatment-as-usual; WAC – wholesale acquisition cost.

Table 3. Medical service utilization rates

	Abstinent	Treated and nonabstinent					Untreated and nonabstinent
Medical service	All years	Year 1	Year 2	Year 3	Year 4	Year 5	Year 1	Year 2	Year 3	Year 4	Year 5
reSET-O + TAU
Hospitalizations	0.06	0.25	0.28	0.31	0.34	0.38	0.18	0.20	0.22	0.24	0.27
ICU stays	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00
PHs	0.04	0.29	0.32	0.36	0.40	0.44	0.21	0.23	0.26	0.28	0.32
ED visits	0.38	1.06	1.18	1.31	1.46	1.62	0.76	0.85	0.94	1.04	1.16
TAU only
Hospitalizations	0.14	0.38	0.42	0.46	0.51	0.57	0.45	0.49	0.55	0.61	0.68
ICU stays	0.00	0.04	0.05	0.05	0.06	0.07	0.05	0.06	0.06	0.07	0.08
PHs	0.04	0.22	0.25	0.27	0.30	0.34	0.27	0.29	0.33	0.36	0.40
ED visits	0.57	1.33	1.47	1.63	1.81	2.01	1.57	1.75	1.94	2.15	2.39
No treatment
Hospitalizations	–	–	–	–	–	–	2.39	2.65	2.94	3.27	3.63
ICU stays	–	–	–	–	–	–	0.03	0.03	0.04	0.04	0.05
PHs	–	–	–	–	–	–	23.06	25.60	28.42	31.54	35.01
ED visits	–	–	–	–	–	–	6.26	6.94	7.71	8.56	9.50

Key: ED – emergency department; ICU – intensive care unit; PH – partial hospitalization; TAU – treatment-as-usual.

Table 4. Medical costs per episode

Medical service	Cost per episode	Sources	Notes
Base-case scenario
Hospitalizations	$4,698	[37]	Estimated cost per encounter 6 months following reSET-O
ICU stays	$22,106	[36,47]	Inflated from $20,500 in 2018 US dollars using the medical care component of the CPI
PHs	$617	[37]	Estimated cost per encounter 6 months following reSET-O
ED visits	$211	[37]	Estimated cost per encounter 6 months following reSET-O
High medical costs scenario
Hospitalizations	$12,650	[36,47]	Inflated from $11,731 in 2018 US dollars using the medical care component of the CPI
ICU stays	$108,115	[47,48]	Inflated from $92,408 in 2015 US dollars using the medical care component of the CPI
PHs	$2,203	[43]	APC 8011 comprehensive observation services
ED visits	$543	[36,47]	Inflated from $504 in 2018 US dollars using the Medical Care Component of the CPI

Key: APC – ambulatory payment classification; CPI – Consumer Price Index; ED – emergency department; ICU – intensive care unit; PH – partial hospitalization; US – United States.

Figure 2. Treatment costs, medical costs, and total costs with and without reSET-O by year.

Table 5. Budget impact results summary

Budget impact	Treatment costs	Medical costs	Total cost	PTMPM	PMPM
Base-case scenario
12 weeks	$1,083	-$8,575	-$7,492	-$22.24	-$0.0024
Year 1	$4,695	-$37,160	-$32,465	-$24.10	-$0.0026
Year 2	$1,926	-$85,029	-$83,103	-$59.89	-$0.0065
Year 3	$2,178	-$145,912	-$143,734	-$100.56	-$0.0110
Year 4	$2,493	-$222,553	-$220,060	-$149.48	-$0.0163
Year 5	$2,874	-$286,538	-$283,663	-$187.07	-$0.0204
Total	$14,166	-$777,192	-$763,026	-$106.68	-$0.0116
High medical costs scenario
12 weeks	$1,083	-$27,545	-$26,462	-$78.57	-$0.0086
Year 1	$4,695	-$119,363	-$114,668	-$85.11	-$0.0093
Year 2	$1,926	-$273,090	-$271,164	-$195.41	-$0.0213
Year 3	$2,178	-$468,574	-$466,396	-$326.31	-$0.0356
Year 4	$2,493	-$714,624	-$712,131	-$483.73	-$0.0527
Year 5	$2,874	-$920,078	-$917,204	-$604.88	-$0.0659
Total	$14,166	-$2,495,729	-$2,481,563	-$346.94	-$0.0378

Key: PMPM – per member per month; PTMPM – per treated member per month.

Figure 3. Tornado diagram of base case one-way sensitivity analysis.

Key: BUP – buprenorphine; OUD – opioid use disorder; PH – partial hospitalization; TAU – treatment-as-usual.

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