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

Abstract

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.

A Methodological Review of US Budget-Impact Models for New Drugs

“…Three of the five studies that used a decision-analytic model structure used only an incident population, those newly starting treatment in the first year of the study, and did not consider whether any patients currently being treated would also switch to the new drug [42,44,45]. Of these three, only one model included a new incident cohort starting treatment each year of the model time horizon [42].…”

“…Of these three, only one model included a new incident cohort starting treatment each year of the model time horizon [42]. The other two models followed a single incident cohort over multiple years [44,45].…”

“…In these studies, the drug for which the budget impact was estimated took treatment share from all drugs (six studies) [33,35,36,42,45,46] or one drug (four studies) [31,38,40,43]. In one study, the drug was added to current therapy [39], and the treatment shares before and after introduction of a new drug were taken from a database analysis in two studies [30,32].…”

“…The fifth decision-analytic model [43] Although these studies focused on chronic conditions, the time horizon assumed was 1 year in seven of the 12 cost-calculator models [31,32,34,37,38,40,41] and only 6 months in one of the cost-calculator models using data from a database analysis [30], implicitly making the assumption that the budget impact would be the same for subsequent periods. In the other four cost-calculator models [33,35,36,39] and the five decision-analytic models [42][43][44][45][46], time horizons varied from 2 to 7 years.…”

“…Of the 17 analyses in which the new drug would not change the mortality or disease progression rates within the model time horizon, 12 used a simple cost-calculator model structure [30][31][32][33][34][35][36][37][38][39][40][41] and five used formal decision-analytic model structures [42][43][44][45][46]. The cost-calculator approach can be appropriate for chronic conditions when the mortality and/or disease progression rates remain constant, and this approach generally has the advantage of being simpler and more transparent for the user.…”