title: Budget impact analysis of tapentadol extended release for the treatment of moderate to severe chronic noncancer pain.
abstract: BACKGROUND
  Opioids are commonly used to manage chronic pain. Although traditional μ-opioids are effective in reducing pain, they are often associated with opioid-induced side effects (OISEs) that can limit treatment effectiveness. Studies have shown that tapentadol extended release (ER) has a lower incidence of gastrointestinal adverse events than oxycodone controlled release (CR) at equianalgesic doses.
  
  
  OBJECTIVE
  A model was developed to estimate the budget impact of placing tapentadol ER on a hypothetical US health plan formulary of Schedule II long-acting opioids.
  
  
  METHODS
  We estimated annual direct health care costs for patients who received 6-month therapy with long-acting formulations of tapentadol, oxycodone, morphine, hydromorphone, oxymorphone, or fentanyl. Costs included medications, copayments, OISE management, and switching/discontinuation. Published estimates of incidence/prevalence, OISEs, and pain management resources and costs were used. The base case analysis assumed a 10% formulary share of tapentadol ER with a 10% decrease of oxycodone CR. The resulting per-member per-month (PMPM) formulary cost differences and results of a 1-way sensitivity analysis are reported.
  
  
  RESULTS
  In a health plan of 500,000 members, 2600 (0.52%) are estimated to experience chronic pain annually. Adding tapentadol ER to the formulary was associated with an annual budget savings of $148,945 ($0.0248 PMPM). This savings was achieved through a decrease in both pharmacy costs ($144,062; $0.0240 PMPM) and medical costs ($4883; $0.0008 PMPM). Cost decreases were driven by lower daily average consumption and fewer OISEs with tapentadol ER versus oxycodone CR, leading to reduced resource utilization over 6 months of treatment. Sensitivity analyses showed results were most sensitive to drug acquisition costs.
  
  
  CONCLUSIONS
  Our results suggest that replacing 10% of oxycodone CR's formulary share with tapentadol ER would decrease the overall budget of a health plan with 500,000 members. Placing tapentadol ER on a health plan formulary may result in a reduction in both pharmacy and medical costs.
authors.affiliation: Janssen Global Services, LLC, Raritan, NJ, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Merchant
authors.forename: Les L
authors.initials: LL
authors.lastname: Noe
authors.forename: Andrew
authors.initials: A
authors.lastname: Howe
authors.forename: Steve
authors.initials: S
authors.lastname: Duff
authors.forename: Joe
authors.initials: J
authors.lastname: Gricar
authors.forename: Kristine
authors.initials: K
authors.lastname: Ogden
authors.forename: Samir H
authors.initials: SH
authors.lastname: Mody
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D002017:Budgets; D059350:Chronic Pain / Q000188:drug therapy* / Q000191:economics; D017046:Cost Savings; D003365:Costs and Cost Analysis; D003692:Delayed-Action Preparations; D005569:Formularies as Topic; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D010098:Oxycodone / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D010636:Phenols / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D012720:Severity of Illness Index; D000077432:Tapentadol; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D010636:Phenols; D010098:Oxycodone; D000077432:Tapentadol