Journal of medical economics · 2025
Budget impact of suzetrigine for the treatment of moderate-to-severe acute pain in Medicaid-insured adults.
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Garrison Kenna, Ellis Alexandra G, Curtice Tammy G, Rosen Melissa M, Sussman Matthew, Lee Jackie, Lopez Andrea
Аннотация
BACKGROUND: Opioids are commonly used to treat moderate-to-severe acute pain in the United States (US) but are associated with serious and costly outcomes including opioid use disorder (OUD). Suzetrigine is the first oral nonopioid treatment approved in the US in over 20 years for the treatment of moderate-to-severe acute pain in adults. The objective of this analysis was to estimate the budget impact of adding suzetrigine to a state Medicaid formulary.
METHODS: A budget impact model (BIM) compared scenarios before and after suzetrigine was available from the perspective of a hypothetical Medicaid plan with 1 million (M) members. The population consisted of adults with moderate-to-severe acute pain managed with prescription medication. Inputs included drug costs and medical costs of treating nausea/vomiting adverse events (AEs) and OUD/opioid abuse. The budget impact of suzetrigine was calculated as the difference in total costs and costs per member per month (PMPM) between the scenarios.
RESULTS: Assuming between 3 and 10 thousand (k) adults with moderate-to-severe acute pain are treated with suzetrigine in place of prescription opioids in the first two years on formulary, suzetrigine was estimated to increase drug costs by $827k to $2.5 M, which was offset by $3.6 M to $10.8 M in savings from avoided nausea/vomiting AEs and OUD/opioid abuse. The addition of suzetrigine to formulary was estimated to result in a budget impact of -$2.8 M to -$8.3 M over two years, or -$0.11 to -$0.34 PMPM, translating to cost savings of $827 per patient treated with suzetrigine rather than an opioid over two years.
CONCLUSION: While suzetrigine was estimated to increase drug costs, the associated avoidance of common opioid AEs and OUD/opioid abuse was estimated to result in cost savings for a state Medicaid plan in the first two years on formulary.
METHODS: A budget impact model (BIM) compared scenarios before and after suzetrigine was available from the perspective of a hypothetical Medicaid plan with 1 million (M) members. The population consisted of adults with moderate-to-severe acute pain managed with prescription medication. Inputs included drug costs and medical costs of treating nausea/vomiting adverse events (AEs) and OUD/opioid abuse. The budget impact of suzetrigine was calculated as the difference in total costs and costs per member per month (PMPM) between the scenarios.
RESULTS: Assuming between 3 and 10 thousand (k) adults with moderate-to-severe acute pain are treated with suzetrigine in place of prescription opioids in the first two years on formulary, suzetrigine was estimated to increase drug costs by $827k to $2.5 M, which was offset by $3.6 M to $10.8 M in savings from avoided nausea/vomiting AEs and OUD/opioid abuse. The addition of suzetrigine to formulary was estimated to result in a budget impact of -$2.8 M to -$8.3 M over two years, or -$0.11 to -$0.34 PMPM, translating to cost savings of $827 per patient treated with suzetrigine rather than an opioid over two years.
CONCLUSION: While suzetrigine was estimated to increase drug costs, the associated avoidance of common opioid AEs and OUD/opioid abuse was estimated to result in cost savings for a state Medicaid plan in the first two years on formulary.