Treatment characteristics of chronic low back pain patients prescribed Belbuca® and buprenorphine transdermal patches: A retrospective US Medicare claims analysis.

OBJECTIVE

To explore buprenorphine treatment characteristics and rescue medication utilization in Medicare-insured chronic low back pain (cLBP) patients prescribed buprenorphine buccal film (Belbuca®) or buprenorphine patch.

DESIGN

A retrospective real-world analysis using Merative MarketScan® Medicare Supplemental and Coordination of Benefits claims database (from January 1, 2018, to December 31, 2021). The first Belbuca or transdermal patch prescription was considered the index date. Patients were observed 6 months pre- and post-index. Exclusion criteria were gap in insurance coverage, opioid use disorder, or cancer during the observation.

SETTING

All levels of clinical care.

PATIENTS: Patients with cLBP (at least two preindex claims with low back pain diagnosis). Propensity-score matching was performed to balance cohorts for covariates.

INTERVENTIONS: Belbuca and buprenorphine transdermal patches.

MAIN OUTCOME MEASURES: Buprenorphine treatment characteristics and rescue medication utilization.

RESULTS

There were 97 matched patients (36 Belbuca, 61 patch). Buprenorphine daily dose was higher in Belbuca (450 mcg vs 260 mcg, p = 0.001), with a wider dosing range (75-1,213 mcg vs 120-716 mcg). Comparing preindex to post-index, initiating Belbuca decreased Schedule II opioid (5.1 vs 3.6, p = 0.038) and long-acting opioid prescription counts (0.8 vs 0.1, p = 0.031), Schedule II opioid treatment duration (103 vs 77 days, p = 0.012), and daily morphine milligram equivalents (42.8 vs 30.4, p = 0.048). In the patch cohort, starting buprenorphine only decreased Schedule II opioid (2.9 vs 4.0, p = 0.014) and short-acting opioid prescription counts (3.7 vs 2.9, p = 0.044).

CONCLUSION

The real-world evidence suggests that elderly cLBP patients may have greater benefits from Belbuca compared to the patch by achieving higher buprenorphine daily doses and decreasing opioid rescue medication use.