Budget Impact Analysis of prolonged-release buprenorphine depot-formulation for the management of patients affected by opioid use disorder

Background: Opioid use disorder (OUD) is a disorder associated with significant rate of morbidity and mortality. Frequent clinic attendance for supervised consumption of sublingual buprenorphine is common. Prolonged-release buprenorphine (PRB) allows a management based on weekly or monthly subcutaneous injections, thus limiting the burdens of clinic attendance and the risks associated with sublingual formulations. Objective: To determine the price level of PRB that allows to obtain a neutral impact from the point of view of the economic resources absorbed, in comparison with the alternatives currently available in the Italian context for the management of patients suffering from OUD. Methods: The analysis assumes a daily PRB cost of €8.526 (neutral cost). The analysis aims to determine the economic impact associated with the introduction of PRB in the Italian context for the management of OUD patients. Results are expressed in terms of differential resourced absorbed in the alternative scenarios. A one-way sensitivity analysis was also carried out to test the robustness of the results. Results: The introduction of PRB implies an increase in the drug acquisition costs over the 5-year time horizon of €19.563.019,13: such costs are fully compensated by the other cost driver considered in the analysis (drug tests provided, health professionals’ time destined to the provision of the treatment, indirect costs, for savings equal to €6.167.026,94, €9.106.824,67 and €4.289.167,53 respectively) demonstrating its effectiveness in particular by an organizational point of view. Lower price levels for PRB would imply significant savings for the SSN. Conclusions: PRB resulted to be associated to a lower level of resources’ absorption in the Italian sector as compared with the available alternatives thus allowing to re-allocate health founds to other fields of the care sector ensuring greater safety for patients and a decreased misuse and diversion rate.

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Budget Impact Analysis of the Introduction of Injectable Prolonged-Release Buprenorphine on Opioid Use Disorder Care Resource Requirements

ClinicoEconomics and Outcomes Research ◽

10.2147/ceor.s242984 ◽

2020 ◽

Vol Volume 12 ◽

pp. 233-240 ◽

Cited By ~ 2

Author(s):

Helen Phillips-Jackson ◽

Clive Hallam ◽

Niamh Cullen ◽

Terry Pearson ◽

Mark Gilman ◽

...

Keyword(s):

Impact Analysis ◽

Budget Impact ◽

Opioid Use Disorder ◽

Budget Impact Analysis ◽

Prolonged Release ◽

Opioid Use ◽

Resource Requirements ◽

P Budget

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Opioid users' willingness to receive prolonged-release buprenorphine depot injections for opioid use disorder

Journal of Substance Abuse Treatment ◽

10.1016/j.jsat.2019.06.007 ◽

2019 ◽

Vol 104 ◽

pp. 64-71 ◽

Cited By ~ 8

Author(s):

Charlotte N.E. Tompkins ◽

Joanne Neale ◽

John Strang

Keyword(s):

Opioid Use Disorder ◽

Prolonged Release ◽

Opioid Use ◽

Depot Injections ◽

Opioid Users ◽

To Receive

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AI4 ECONOMIC IMPACT ANALYSIS AND PREDICTIVE MODELING IDENTIFYING RISK FACTORS FOR OPIOID USE DISORDER IN MEDICAID MANAGED CARE POPULATIONS

Value in Health ◽

10.1016/j.jval.2019.04.008 ◽

2019 ◽

Vol 22 ◽

pp. S34

Author(s):

J. Jones ◽

W. Gao ◽

D. Keleti ◽

Y. Chen ◽

P. Mistry

Keyword(s):

Risk Factors ◽

Managed Care ◽

Economic Impact ◽

Predictive Modeling ◽

Impact Analysis ◽

Opioid Use Disorder ◽

Opioid Use ◽

Medicaid Managed Care ◽

Economic Impact Analysis

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A Smartphone-Smartcard Platform for Implementing Contingency Management in Buprenorphine Maintenance Patients With Concurrent Stimulant Use Disorder

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.778992 ◽

2021 ◽

Vol 12 ◽

Author(s):

Anthony DeFulio ◽

Joshua Furgeson ◽

Hayley D. Brown ◽

Shawn Ryan

Keyword(s):

Contingency Management ◽

Intervention Group ◽

Opioid Use Disorder ◽

Drop Out ◽

Opioid Use ◽

Clinic Attendance ◽

Opioid Agonist ◽

Stimulant Use ◽

Management Intervention ◽

Drug Abstinence

Background and Objectives: Opioid agonist pharmacotherapies are effective in the treatment of opioid use disorder (OUD) but concurrent stimulant use is common and can lead to relapse and treatment drop out. Contingency management in combination with opioid agonist pharmacotherapy has broad beneficial effects in polysubstance users, including promoting drug abstinence and treatment retention, but clinic-based implementation can be burdensome. The present study was conducted to evaluate a contingency management intervention delivered via a smartphone-smartcard platform in OUD patients who had concurrent stimulant use disorder.Methods: Retrospective comparison of (n = 124) patients; half received the contingency management intervention and half were matched controls. Drug use and clinic attendance outcomes over four consecutive 30-day periods were analyzed with regression.Results: The intervention group showed consistently higher rates of drug abstinence and clinic attendance which were significant at the latter two timepoints.Discussion: Smartphone-smartcard platforms can facilitate dissemination of contingency management by surmounting or obviating key barriers to adoption. They appear to be convenient for all stakeholders, are easy to use, and facilitate high-fidelity implementation. Delivering contingency management via a smartphone-smartcard platform produces effects consistent with those observed when the intervention is delivered with substantially costlier and more burdensome in-person procedures.

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Perception of a New Prolonged-Release Buprenorphine Formulation in Patients with Opioid Use Disorder: The PREDEPO Study

European Addiction Research ◽

10.1159/000520091 ◽

2021 ◽

pp. 1-12

Author(s):

Francisco Salvador Pascual ◽

Alvaro Muñoz ◽

Rodrigo Oraa ◽

Gerardo Flórez ◽

Pilar Notario ◽

...

Keyword(s):

Opioid Dependence ◽

Opioid Use Disorder ◽

Prolonged Release ◽

Opioid Use ◽

Cross Sectional ◽

Likert Scales ◽

Suitable Alternative ◽

Response Options ◽

Monthly Injection ◽

The Mean

Aim: The aim of the study was to assess the acceptance of patients with opioid use disorder (OUD) to switching their opioid dependence treatment (ODT) for a prolonged-release buprenorphine (PRB) injection according to their prior ODT (buprenorphine/naloxone [B/N] or methadone). Methods: This was an observational, retrospective/cross-sectional, multicentre study of adult patients diagnosed with OUD on ODT. Data collected from diaries were analysed to know their interest and opinion on PRB. Questions with fixed response options were included, and several Likert scales were used. Results: A total of 98 patients were enrolled (B/N: 50.0%, methadone: 50.0%). The mean age was 46.9 ± 8.43 years and 79.6% were males. PRB was similarly perceived by both groups in most variables analysed, receiving a mean score of 7.2/10 (B/N: 7.4, methadone: 7.0; p = 0.520), and approximately 65% of patients said they were willing to switch to PRB (B/N: 63.3%, methadone: 65.3%; p = 0.833). Of these, a higher percentage in the B/N group considered that switching would be easy/very easy (B/N: 90.3%, methadone: 46.9%; p < 0.001) and that they would start PRB when available (B/N: 64.5%, methadone: 34.3%; p = 0.005). More than 90% would prefer the monthly injection (B/N: 93.6%, methadone: 100%; p = 0.514). One-third of patients in both groups were unsure/would not switch their ODT to PRB (B/N: 36.7%, methadone: 34.7%; p = 0.833). The main reason was administration by injection. Conclusion: Two-thirds of patients would switch their treatment for PRB, and most patients on B/N considered that switching would be easy. PRB could be a suitable alternative for OUD management.

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Opioid use disorder in Germany: healthcare costs of patients in opioid maintenance treatment

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-019-0247-9 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Jens Reimer ◽

Tobias Vogelmann ◽

Daniel Trümper ◽

Norbert Scherbaum

Keyword(s):

Healthcare Costs ◽

Maintenance Treatment ◽

Hospital Costs ◽

Opioid Use Disorder ◽

Cost Driver ◽

Health Claims ◽

Opioid Use ◽

Opioid Maintenance Treatment ◽

Health Claims Data ◽

The Cost

Abstract Background Opioid Use Disorder (OUD) is a substance use disorder with a chronic course associated with comorbid mental and somatic disorders, a high burden of psychosocial problems and opioid maintenance treatment (OMT) as a standard treatment. In the US, OUD imposes a significant economic burden on society, with annual societal costs estimated at over 55 billion dollars. Surprisingly, in Europe and especially in Germany, there is currently no detailed information on the healthcare costs of patients with OUD. The goal of the present research is to gather cost information about OUD patients in OMT with a focus on maintenance medication and relapses. Methods We analysed health claims data of four million persons covered by statutory health insurance in Germany, applying a cost-of-illness approach and aimed at examining the direct costs of OMT patients in Germany. Patients with an ICD-10 code F11.2 and at least one claim of an OMT medication were stratified into the treatment groups buprenorphine, methadone or levomethadone, based on the first prescription in each of the follow-up years. Costs were stratified for years with and without relapses. Group comparisons were performed with ANOVA. Results We analysed 3165 patient years, the total annual sickness funds costs were on average 7470 € per year and patient. Comparing costs of levomethadone (8400 €, SD: 11,080 €), methadone (7090 €, SD: 10,900 €) and buprenorphine (6670 €, SD: 7430 €) revealed significant lower costs of buprenorphine compared to levomethadone (p < 0.0001). In years with relapses, costs were higher than in years without relapses (8178 € vs 7409 €; SD: 11,622, resp. 10,378 €). In years with relapses, hospital costs were the major cost driver. Conclusions The present study shows the costs of OUD patients in OMT for the first time with a German dataset. Healthcare costs for patients with an OUD in OMT are associated with more than two times the cost of an average German patients. Preventing relapses might have significant impact on costs. Patients in different OMT were dissimilar which may have affected the cost differences.

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Opening the “black box”: Four common implementation strategies for expanding the use of medications for opioid use disorder in primary care

Implementation Research and Practice ◽

10.1177/26334895211005809 ◽

2021 ◽

Vol 2 ◽

pp. 263348952110058

Author(s):

Lauren Caton ◽

Hanyang Shen ◽

Gloria M Miele ◽

Kendall Darfler ◽

Jose R Sandoval ◽

...

Keyword(s):

Primary Care ◽

Clinical Skills ◽

Implementation Strategies ◽

Opioid Use Disorder ◽

Plain Language ◽

Opioid Use ◽

Clinic Attendance ◽

Learning Collaboratives ◽

Opioid Use Disorders ◽

The Impact

Background: Despite the persistent increase in overdose deaths, access to medications for opioid use disorders remains limited. Recent federal funding aimed at increasing access prompts a need to understand if implementation strategies improve access. Methods: This is an analysis of data from 174 primary care clinics enrolled in a state-wide medications for opioid use disorders (MOUD) implementation effort in California. We examined clinic use of one of four implementation strategies: learning collaboratives, Project Extension for Community Health care Outcomes (ECHO), didactic webinars, and clinical skills trainings. The primary implementation outcome was categorical change in new patients prescribed buprenorphine. Univariate and multivariate logistic regressions were used to determine the impact of clinic attendance in all or individual implementation strategies, respectively, on patient growth. Results: Clinics attending learning collaboratives, Project ECHO, and clinical skills trainings had significantly higher odds of patient growth (odds ratio [OR] = 3.56; 95% confidence interval [CI] = 1.78, 7.10, p < .001), (OR = 3.39; 95% CI = 1.59, 7.24, p < .01), (OR = 3.90, 95% CI = 1.64, 9.23, p < .01) than non-attending clinics. The impact of attendance at learning collaboratives (OR = 5.81, 95% CI = 1.89, 17.85; p < .01), didactic webinars (OR = 3.59; 95% CI = 1.04, 12.35; p < .05), and clinical skills trainings (OR = 3.53, 95% CI = 1.06, 11.78, p < .05) on patient growth was greater for Federally Qualified Health Centers. When comparing strategies in multivariate models, only the relationship between learning collaborative attendance and new patients prescribed buprenorphine remained significant (OR = 2.57; 95% CI = 1.12, 5.88; p < .05). Conclusions: This study reported on a large, statewide, implementation-as-usual project offering four typical implementation strategies. Clinic attendance at learning collaboratives, a multi-component strategy, had the most consistent impact on new patients prescribed buprenorphine. These results suggest that while a broad array of strategies was initially reasonable, optimizing the selection of implementation strategies could be more effective. Plain Language Summary Access to life-saving medications for opioid use disorder, such as buprenorphine, remains limited despite strong evidence of effectiveness. Systems and organizations often select from a variety of implementation strategies aimed at expanding access to these medications. However, scant research exists to enable these organizations to select the most effective and efficient strategies. Our study—within a large state-wide system of care—examined the impact of primary care clinic attendance in four common implementation strategies on new patients prescribed buprenorphine. Learning collaboratives were the strategy that most consistently improved outcomes. These results highlight the challenges to strategy selection inherent in implementation-as-usual systems-level approaches. The field needs evidence-based information on which implementation strategies are most likely to yield desired implementation outcomes.

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