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Clinical Outcomes Translated to Healthcare Costs: Comparison of Buprenorphine Pain Medications with Full-agonist Extended-Release Opioids

P-020 - (Poster #20) Clinical Outcomes Translated to Healthcare Costs: Comparison of Buprenorphine Pain Medications with Full-agonist Extended-Release Opioids

Thursday, September 4, 2025
4:00 PM - 5:30 PM PST
Location:  Exhibit Hall (Level 4)
Background: Opioid use disorder and overdose-related healthcare costs are estimated at $35 billion/year (Florence et al., 2021). Buprenorphine is a partial opioid agonist with buccal film and transdermal patch formulations approved for severe and persistent pain. Buprenorphine has potentially fewer negative side effects and adverse events than other opioids used for chronic pain treatment (Adler et al., 2024), such as full-agonist opioids fentanyl, hydromorphone, morphine and oxycodone (Dalal et al., 2021). Against the background of the magnitude spent on the opioid crisis and awareness of the need for knowledge on multiple treatment options for pain, the use of buprenorphine for pain management is increasing. The National Poison Data System (NPDS) is the data warehouse for the nation’s 53 Poison Centers often used to evaluate drug safety. Each poison center submits de-identified case data to NPDS after providing necessary poison exposure management and information services to callers. This case information is uploaded to NPDS in near real time, making NPDS one of the few operational systems of its kind (https://poisoncenters.org/national-poison-data-system). Rates of abuse and related clinical outcomes can be analyzed for medications of interest, making it a valuable real-world data source.

Purpose/Objectives: The purpose of this health economics and outcomes research (HEOR) was to translate clinical outcomes associated with buprenorphine formulations for analgesia and full-agonist opioid exposures into estimated healthcare costs using real-world data.

Methods: This was an observational, cross-sectional study design with three groups: buprenorphine buccal film (BBF), buprenorphine transdermal patch (BTP) and full-agonist extended-release opioids (FA-ER; included ER oxycodone, ER hydromorphone, ER oxymorphone, and ER tapentadol). Exposures between 01 January 2020 and 31 December 2023 resulting in hospital admissions or emergency department (ED) visits following intentional abuse/misuse of BBF, BTP, or FA-ER opioids were extracted from NPDS. Exposure rates were then adjusted for population (per 100,000 US population) and drug utilization (per 100 million dosage units) by using estimates of prescription and dosage units dispensed from IQVIA™; an industry standard source of national prescription activity for all pharmaceutical products.  The Healthcare Cost and Utilization Project (HCUP) is a family of healthcare databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). Use of the HCUP data is solely for research purposes. The most recent HCUP data from 2020 were used to estimate average costs for opioid-related hospital admission ($20,706) and opioid-related ED visits ($3,795). These values were multiplied by exposure rates to generate per product cost estimates for each type of visit. Rates were generated with SAS Proc Genmod.

Results:

From 01 January 2020 to 31 December 2023, there were 276 reported exposures to BBF; 134 reported exposures to BTP; and 2,453 reported exposures to FA-CII opioids. Of these, intentional abuse or misuse exposures involving BBF and BTP were similar to one another and lower than rates of FA-ER exposures: BBF intentional abuse/misuse exposures n= 41 (14.9%); BTP exposures n=19 (14.2%); and FA-ER opioid exposures n= 665 (27.1%).  Percentages of admissions to a healthcare facility following intentional abuse/misuse exposures were similar between BTP (n=5, 26.3%) and BBF (n=11, 26.8%) products, both of which were less than FA-ER opioid intentional abuse/misuse exposure-related admissions (n=205, 30.8%).  Percentages of admission to a healthcare facility were adjusted for 100,000 population and 100 million dosage units dispensed, revealing significantly lower rates of admission associated with BBF products than BTP or FA-ER opioids: BBF rate = 0.37 (95%CI: 0.21-0.67); BTP rate = 1.65 (95% CI=0.69-3.95); FA-ER opioid rate = 1.33 (95% CI = 1.16-1.52). Extrapolated opioid-related hospital admission costs were lower for BBF ($7,681, 95% CI $7,227-$8,134) than BTP ($34,080, 95% CI $32,069-$36,092) and FA-ER ($27,488, 95% CI $25,866-$29,111).
ED visits are defined as exposures that categorized the medical outcome as Treated/Evaluated/Released in the NPDS lexicon. Of the intentional abuse/misuse exposures, n=16 (39.0%) BBF, n=6 (31.6%) BTP, and n=288 (43.0) FA-ER opioid exposures were coded as ED visits.  ED visits were adjusted per 100,000 population and 100 million dosage units dispensed, revealing significantly lower rates of admission associated with BBF products than BTP or FA-ER opioids: BBF=0.54 (95%CI 0.33-0.88); BTP=1.98 (95% CI 0.89-4.40) and FA-ER Opioids (95% CI 1.66-2.09). Extrapolated opioid-related ED visit costs were lower for BBF ($2,048, 95% CI $1,851-$2,245) than BTP ($7,496, 95% CI $6,775-$8,216) and FA-ER ($7,078, 95%CI $6,397-$7,759).  

Conclusions/Implications for future research and/or clinical care: When considering population- and drug utilization-adjusted rates of intentional abuse/misuse exposure, opioid-related hospitalization and ED visits were less likely to occur after exposure to BBF than for BTP or FA-ER opioids. The estimated healthcare costs associated with these exposure rates also demonstrated significantly lower healthcare costs associated with BBF compared to BTP and FA-ER opioids.  Limitations of this study include that the NPDS data are self-reported although recorded and vetted by a healthcare professional. NPDS data include only what is reported to poison centers and does not capture all exposures (Mowry et al., 2023). Healthcare costs for a specific ED visit or hospital admission may vary due to the severity of the exposure and sequelae, however, this level of variability cannot be fully accounted for with the present model. Interpretation of rates and cost estimates should focus on the relative differences between the comparators and not the absolute costs. Taken as a whole, the NPDS and HCUP are real-world data sources that provide helpful tools for studying healthcare costs. These data reveal potential healthcare cost-savings associated with BBF relative to BTP and FA-ER opioids.