Economic and Treatment Burden of Chronic Low-Back Pain Patients Transitioning from Short-Acting to Long-Acting Opioids or Buprenorphine Buccal Film: US Claims Analysis

This study aimed to assess economic burden and treatment characteristics of patients with chronic low-back pain (cLBP) transitioning from oral Schedule II (CII) short-acting opioids (SAO) to oral CII long-acting opioids (LAO) or Belbuca® (buprenorphine buccal film, BBF). Merative MarketScan® commercial US claims (2019–2023) were retrospectively analyzed. Index date was the first BBF or LAO prescription date. The observation covered 6-month pre-index and 12-month follow-up periods. Patients were adults with ≥ 2 low-back pain and ≥ 1 SAO prescription pre-index claims. Cases with BBF-LAO switching, coverage gap, or cancer/HIV were excluded. Economic burden and treatment characteristics were explored during follow-up. Rescue medication utilization trends were also analyzed (6-month pre-index vs. 6-month follow-up). Propensity-score matching minimized the impact of patient characteristics. Study sample had 964 patients per cohort. Despite higher prescription costs in BBF ($10,417 vs. $8238, p = 0.007), total and cLBP-related costs were similar. BBF had fewer outpatient visits (33.1 vs. 35.4, p = 0.038), hospitalizations (0.2 vs. 0.3, p = 0.041), cLBP-related hospitalizations (0.04 vs. 0.08, p = 0.013), and shorter cLBP-related hospital stay (0.14 vs. 0.33 days, p = 0.023). BBF also had fewer patients with ED visits (36.9% vs. 41.6%, p = 0.036) and cLBP-related hospitalizations (3.5% vs. 6.1%, p = 0.008). Adherence and treatment duration between cohorts were similar, with fewer prescriptions in BBF (5.8 vs. 6.5, p = 0.003). Trends showed BBF had greater decreases in SAO treatment duration (− 15.4 vs. − 2.2 days, p < 0.001), prescription counts (− 0.9 vs. − 0.3, p < 0.001), and daily morphine milligram equivalents (− 9.7 vs. − 6.1, p = 0.015). However, more BBF-treated patients had buprenorphine patches (8.2% vs. 3.3%, p < 0.001) with more patch prescriptions (0.3 vs. 0.1, p < 0.001) and longer treatment duration (8.9 vs. 2.6 days, p < 0.001). Study findings demonstrated similar healthcare expenditures between patients with cLBP transitioning from SAO to BBF and to LAO. Yet, initiating BBF may have lowered healthcare resource utilization and decreased further SAO utilization. This study compared two treatments for adults with chronic low-back pain. All participants were using short-acting opioid pills. Researchers wanted to find out how starting a different medication, a long-acting opioid pill or a buprenorphine buccal film (brand name Belbuca), affected healthcare costs, the use of medical services, and the use of other pain medications. Researchers analyzed the health insurance claims of a large group of US patients. They compared two matched groups—one started treatment with buprenorphine buccal film and the other with a long-acting opioid pill. The study then tracked these patients for 1 year, looking at their medical costs, how often they needed medical services, and their use of other pain medications. While the prescription costs for the buprenorphine buccal film group were higher, the total healthcare costs for both groups were similar. However, the group using buprenorphine buccal film had fewer outpatient visits, fewer hospitalizations (especially those related to their back pain), and fewer visits to the emergency room. This group also had a shorter duration of hospital stay associated with the low-back pain. Patients who started buprenorphine buccal film also significantly reduced their use of the short-acting opioid pill, but used more buprenorphine patches than the other group. Both groups had similar durations of treatment and showed similar levels of adherence, meaning they took their medication as prescribed for a similar length of time.