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Probuphine: Benefits and Cost of a New Medication-Assisted SUD Treatment Option

How will implants affect care?

[reposted from the CHERISH blog]

Following approval by the US Food and Drug Administration (FDA), probuphine will become the latest medication-assisted treatment (MAT) option to treat opioid use disorders in the United States. Probuphine is a subdermal implant that consists of four one-inch rods that deliver a daily dose of 8 mg of buprenorphine, an opioid agonist that staves off opioid cravings and withdrawal. Unlike daily medications such as methadone or sublingual buprenorphine/naloxone, patients prescribed probuphine will receive the daily dose of buprenorphine continuously for six months. Although patients will not be required to take daily medication, the FDA recommends that patients receive the medication “as part of a complete treatment program that includes counseling and psychosocial support.” Probuphine is only recommended for clinically stable patients who are prescribed low doses of buprenorphine.

There are many advantages to probuphine, such as reducing the risk of medication diversion and increased medication adherence. For example, one former user commented on NIDA director Nora Volkow’s blog post that unlike traditional MAT options, probuphine would increase medication adherence during changing circumstances such as incarceration or homelessness. The standardized dose of buprenorphine may be a limitation, however, for patients who require higher or lower doses.

What about the cost of probuphine? Braeburn Pharmaceuticals, the manufacturer of probuphine, has put an expensive price tag on the implant ($4950) compared to the price of sublingual buprenorphine/naloxone ($1330 for 6 months of an equivalent dosage). A reduction in physician visits and medication pickups, however, could ultimately offset some of this initial cost difference. Methadone treatment has a much lower medication price but requires that the patient visit the methadone clinic very frequently, up to 6 days a week. Thus, especially from the patient perspective, probuphine could save cost and time. From a societal perspective, probuphine may reduce the number of patients lost to follow up. More research is needed to understand the cost-effectiveness and comparative effectiveness of this new medication.

There will be additional start-up costs for prescribers. The availability and access to buprenorphine is affected by regulations that require physicians to receive special training and licensing to prescribe buprenorphine and limits the number of patients per prescriber. According to Braeburn Pharmaceuticals, physicians will be required to attend training courses both to prescribe probuphine and for technical training to insert the implant. It is also uncertain whether a patient prescribed probuphine will be counted towards the buprenorphine patient limit, which was recently increased from 100 to 275 for certain physicians. More research is needed to evaluate the impact of these requirements on probuphine availability.

Sarah Gutkind is part of the Administrative Core of the Center for Health Economics of Treatment Interventions for Substance Use Disorders, HCV, and HIV (CHERISH), a NIDA-funded multi-institutional center.