Persistence and healthcare utilization associated with the use of buprenorphine/naloxone film and tablet formulation therapy in adults with opioid dependence

Abstract

Patients treated with the film formulation of buprenorphine/naloxone appeared to stay longer on treatment, have a lower probability of hospital admission, and lower health care costs compared to patients treated with the tablet. This study, based on insurance claims data, has the advantage of reflecting real-world practice, but one cannot rule out the existence of bias due to differences in patient or prescriber profiles, despite adjustments made for observed characteristics at treatment initiation.

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

“…It is common for a mental disorder to be estimated using the resource use as inpatient days for psychiatric and inpatient stays for non-psychiatric reasons. This was consistent with the methods used in the previous study 21 . For acquisition of buprenorphine/naloxone, monthly numbers of tablets or film by strength were estimated using a generalized linear model with gamma distribution and a log-link, and multiplied by prices per unit obtained as detailed below.…”

“…In a study based on Medicaid claims, 56% of the patients receiving the sublingual film formulation were still treated after 12 months versus only 46% of those receiving the tablet formulation (p50.0001). In privately insured patients, the same trend was observed with a persistence at 6 months significantly higher for the film group than for the tablet group (63.78% vs. 58.13%; p ¼ 0.002) 21 .…”

“…The sublingual film technology was developed and packaged in a single, child resistant unit dose and numbered packages intended to reduce misuse and diversion rates. Although there are only very few studies available in this area, earlier retrospective studies based on insurance claims data showed that treatment with Suboxone sublingual film is associated with better treatment retention as well as lower healthcare costs in all treatment phases (initiation, treatment, discontinuation, off-treatment and reinitiation) compared to treatment with buprenorphine/naloxone tablets 20,21 . In a study based on Medicaid claims, 56% of the patients receiving the sublingual film formulation were still treated after 12 months versus only 46% of those receiving the tablet formulation (p50.0001).…”

Economic Evaluations of Opioid Use Disorder Interventions

“…Clay et al[44] conducted a retrospective cohort analysis of opioid-dependent beneficiaries of a commercial U.S. healthcare insurance company. Beneficiaries who had initiated treatment with buprenorphine/naloxone film were compared to those who had initiated treatment with the tablet version of the drug.…”

“…Overall, findings from these articles indicate that in spite of the higher outpatient or prescription costs associated with the therapy, pharmacotherapy for opioid use disorders is associated with lower total healthcare costs due primarily to lower utilization of high-cost services such as ED use and inpatient care. Other outcomes of interest included lower criminal-justice-related costs associated with methadone maintenance therapy (MMT),[39] lower costs associated with buprenorphine/naloxone film versus tablets,[44, 45] and improved retention for high-dose versus low-dose buprenorphine/naloxone patients, with no significant increase in total direct healthcare costs. [46]…”