Budgetary impact of the utilization of @entity4783 / XXXX sublingual film and tablet for Medicaid in the United States.

@entity1 @entity146 @entity4784 @entity4783 @entity1510
OBJECTIVES: The @entity4783 / @entity1510 combination for the treatment of @entity4784 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 @entity4783 / @entity1510 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 @entity1 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- @entity146 hospitalization. CONCLUSIONS: While using the sublingual film formulation for more @entity1 treated with @entity4783 / @entity1510 is predicted to increase outpatient care costs, it would generate savings in emergency care and hospitalizations. In the treatment of @entity4784 , total direct medical costs for Medicaid would be lower for sublingual film treated @entity1 , at current drug prices.
