Opioids are used to treat both acute and chronic pain; however, traditional μ-opioids are often associated with opioid-induced side effects that can limit treatment effectiveness. Issues with tolerability have led to the development of novel opioids that may have a more favorable adverse event profile. Clinical studies for a long-acting form of a new opioid developed by this client found a more favorable side effect profile compared with traditional μ-opioids. Improved tolerability may lead to greater adherence and persistence with therapy, and reduced costs associated with manging opioid-induced side effects. We were asked to develop a budget impact model assessing the potential budget impact of adding a new long-acting opioid to health plan formularies.
We worked closely with the client to develop a budget impact model that included inputs relevant to US managed care formulary decision-makers, including medication and adverse event management costs. The model included commonly used Schedule II long-acting opioids, and considered both medical and pharmacy costs based on the published literature and clinical trial data. We established before and after formulary scenarios to estimate the budget impact of adding this new treatment to the formulary of a hypothetical health care plan.