title: Budgetary impact of the utilization of buprenorphine/naloxone sublingual film and tablet for Medicaid in the United States.
abstract: OBJECTIVE
  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.
authors: a a University of Illinois College of Medicine at Peoria/University of Illinois at Chicago College of Pharmacy , Peoria , IL , USA.
authors: Carl V
authors: CV
authors: Asche
authors: b b Creativ-Ceutical , Paris , France.
authors: Emilie
authors: E
authors: Clay
authors: c c Creativ-Ceutical , Chicago , IL , USA.
authors: Elizaveta
authors: E
authors: Kharitonova
authors: d d ZRx Outcomes Research Inc. , Mississauga , ON , Canada.
authors: Vladimir
authors: V
authors: Zah
authors: e e Reckitt Benckiser Pharmaceuticals Inc. , Richmond , VA , USA.
authors: Jane
authors: J
authors: Ruby
authors: b b Creativ-Ceutical , Paris , France.
authors: Samuel
authors: S
authors: Aballéa
mesh_terms: D000286:Administration, Sublingual; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000191:economics*; D000069479:Buprenorphine, Naloxone Drug Combination / Q000008:administration & dosage / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D008484:Medicaid / Q000191:economics*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000191:economics*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013607:Tablets; D013997:Time Factors; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D013607:Tablets
keywords: Budget impact model; Buprenorphine/naloxone; Healthcare expenditures; Medicaid