Document Detail


Alcohol dependence treatments: comprehensive healthcare costs, utilization outcomes, and pharmacotherapy persistence.
MedLine Citation:
PMID:  21761948     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVES: To determine the healthcare costs associated with treatment of alcohol dependence with medications versus no medication and across the 4 medications approved by the US Food and Drug Administration (FDA).
STUDY DESIGN: Retrospective claims database analysis.
METHODS: Eligible adults with alcohol dependence were identified from a large US health plan and the IMS PharMetrics Integrated Database. Data included all medical and pharmacy claims at all available healthcare sites. Propensity score-based matching and inverse probability weighting were applied to baseline demographic, clinical, and healthcare utilization variables for 20,752 patients, half of whom used an FDA-approved medication for alcohol dependence. A similar comparison was performed among 15,502 patients treated with an FDA-approved medication: oral acamprosate calcium (n = 8958), oral disulfiram (n = 3492), oral naltrexone (NTX) hydrochloride (n = 2391), or extended-release injectable naltrexone (XR-NTX; n = 661). Analyses calculated 6-month treatment persistence, utilization, and paid claims for: alcoholism medications, detoxification and rehabilitation, alcohol-related and nonrelated inpatient admissions, outpatient services, and total costs.RESLUTS: Medication was associated with fewer admissions of all types. Despite higher costs for medications, total healthcare costs, including inpatient, outpatient, and pharmacy costs, were 30% lower for patients who received a medication for their alcohol dependence. XR-NTX was associated with greater refill persistence and fewer hospitalizations for any reason and lower hospital costs than any of the oral medications. Despite higher costs for XR-NTX itself, total healthcare costs were not significantly different from oral NTX or disulfiram, and were 34% lower than with acamprosate.
CONCLUSION: In this largest cost study to date of alcohol pharmacotherapy, patients who received medication had lower healthcare utilization and total costs than patients who did not. XR-NTX showed an advantage over oral medications in treatment persistence and healthcare utilization, at comparable or lower total cost.
Authors:
Onur Baser; Mady Chalk; Richard Rawson; David R Gastfriend
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of managed care     Volume:  17     ISSN:  1936-2692     ISO Abbreviation:  Am J Manag Care     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-07-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9613960     Medline TA:  Am J Manag Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S222-34     Citation Subset:  H    
Affiliation:
852 Winter St, Waltham, MA 02139.E-mail: david.gastfriend@alkermes.com.
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