P-083 - Decreased Cost Utilization with Lidocaine Topical System 1.8% Compared to Lidocaine 5% Patch: A Retrospective Claims Analysis.

Abstract Title: Decreased Cost Utilization with Lidocaine Topical System 1.8% Compared to Lidocaine 5% Patch: A Retrospective Claims Analysis.

Background: Topical lidocaine is a well-established treatment for post-herpetic neuralgia (PHN) however, there is significant utilization in patients with lower back pain (LBP)^[3,4]. Chronic LBP, which comprises both nociceptive and neuropathic pain, is often treated with topical lidocaine for the neuropathic component. Lidocaine Topical System 1.8% (LTS) and Lidocaine 5% Patch (LP) are bioequivalent lidocaine patches identical in size, with LTS providing more than 10 times the bioavailability compared to LP and associated generics^[1]. The novel adhesion technology of LTS has demonstrated superior adhesion performance and more efficient drug delivery compared to generic LP in randomized, comparative clinical trials^[2]. Patch adhesion is an essential factor for optimal pain management, with poor adhesion leading to suboptimal pain relief and potential increases in healthcare resource utilization (HCRU) and associated costs.

Purpose/Objectives: Use retrospective claims data to assess the impact of LTS versus LP on all-cause costs incurred during office, outpatient, emergency room (ER)/urgent care visits, and costs associated with pain procedures.

Methods: This review was a retrospective claims analysis using OPTUM’s De-identified Normative Health Informatics database consisting of commercial and Medicare Advantage claims from April 1, 2018, through March 31, 2023, to assess claims for adults diagnosed with LBP. Eligible patients were divided into two cohorts: those with a prescription for LTS (n = 1847) and those with a prescription for LP (n = 17,640), with the index event defined as the first prescription fill of either LTS or LP. The OPTUM standard cost analysis algorithm was used to establish all-cause costs per patient within the 6-month period preceding, and the 6-month period following the index event. For each cohort, unadjusted matched non-zero pre- and post-index comparison was performed using the Wilcoxon rank sum test.

Results: In total, patients treated with LTS demonstrated a reduction in cost while patients treated with LP were associated with an increase in cost in the post-index setting. The median cost of office visits per LTS patient was $2518 pre-index and $2439 post-index (-3%, p=0.003), the median cost of ER/urgent care visits per LTS patient was $1574 pre-index and $1017 post-index (-35%, p=0.663), the median cost of outpatient visits per LTS patient was $2977 pre-index and $2984 post-index (+0.2%, p=0.906 ) and the median cost of pain procedures per LTS patient was $1150 pre-index and $1155 post-index (+0.4%, p=0.107).

In contrast, the median cost of office visits per LP patient was $1862 pre-index and $1898 post-index (+2%, p=0.04), the median cost of ER/urgent care visits per LP patient was $2558 pre-index and $2501 post-index (-2%, p=0.624), the median cost of outpatient visits per LP patient was $3636 pre-index and $3926 post-index (+8%, p< 0.001), and the median cost of pain procedures per LP patient was $956 pre-index and $1024 post-index (+7%, p< 0.001).

Conclusions/Implications for future research and/or clinical care: The overall cost reduction observed in the LTS cohort, and the cost increase observed in the LP cohort suggests that LTS may be associated with lower costs of care compared to LP due to better pain relief as a result of the superior adhesion qualities of LTS. This analysis demonstrates the potential for improved pain management and subsequent cost savings of using LTS compared to the generic LP for neuropathic pain.

References: [1] Gudin, Jeffrey et al. “A Randomized, Open-Label, Bioequivalence Study of Lidocaine Topical System 1.8% and Lidocaine Patch 5% in Healthy Subjects.” Journal of pain research vol. 13 1485-1496. 22 Jun. 2020, doi:10.2147/JPR.S23793

[2] Gudin, Jeffrey et al. “Open-Label Adhesion Performance Studies of a New Lidocaine Topical System 1.8% versus Lidocaine Patches 5% and Lidocaine Medicated Plaster 5% in Healthy Subjects.” Journal of pain research vol. 14 513-526. 23 Feb. 2021, doi:10.2147/JPR.S287153

[3] Baron, R et al. “Neuropathic low back pain in clinical practice.” European journal of pain (London, England) vol. 20,6 (2016): 861-73. doi:10.1002/ejp.838

[4] Santana, Javier A et al. “The Efficacy, Effectiveness and Safety of 5% Transdermal Lidocaine Patch for Chronic Low Back Pain: A Narrative Review.” PM & R: the journal of injury, function, and rehabilitation vol. 12,12 (2020): 1260-1267. doi:10.1002/pmrj.12366