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Comparison of Healthcare Utilization Among Patients Treated With Alcoholism Medications

Tami L. Mark, PhD; Leslie B. Montejano, MA; Henry R. Kranzler, MD; Mady Chalk, PhD; and David R. Gastfriend, MD

Treatment of alcohol dependence with medications offered advantages in reduced healthcare utilization and costs compared with usual treatment without medications.

These findings are clinically significant and address the significant gap in information on the effects of alcoholism medications in clinical practice. Despite general research that has shown benefits of these medications in the treatment of alcohol dependence and the recommendation by the National Institute on Alcohol Abuse and Alcoholism4 that providers should consider the use of approved medications for the treatment of all patients with alcohol dependence, it is estimated that more than 90% of patients diagnosed as having alcohol dependence do not receive such pharmacotherapy.5 In this study, we found a consistent pattern of better outcomes associated with pharmacotherapy than with no pharmacotherapy. Similarly, naltrexone XR use was associated with better outcomes than the use of oral alcoholism medications in many comparisons. Differences are clinically and economically meaningful. For example, when inpatient detoxification days are converted to hospital charges using the mean daily charges reported by US insurers (based on Healthcare Cost and Utilization Project National Inpatient Sample data for 2007 from the US Agency for Healthcare Research and Quality [http:// hcupnet.ahrq.gov/]), naltrexone XR use was associated with significantly lower detoxification costs ($0.60 million per 1000 patients over 6 months) than oral naltrexone use ($1.48 million, P <.01), disulfiram ($1.08 million, P = .05), or acamprosate ($1.40 million, P <.01) (Table 4).

Prior studies6,8-10 of oral naltrexone have shown that most patients do not persist through a clinically relevant course of treatment, and nonpersistence has been associated with significantly more intensive healthcare services utilization.9 In the present study, the group receiving naltrexone XR had greater medication utilization and lower inpatient services utilization and costs than the groups receiving oral alcoholism medications. These findings may be attributable to the administration of naltrexone XR formulation on a monthly basis rather than a daily basis. The findings from this study have important implications for alcohol dependence pharmacotherapy and provide support for the use of FDA-approved medications, particularly naltrexone XR, in clinical settings. Additional comparative research on alcohol dependence pharmacotherapy using larger samples and longer durations of treatment is needed to enhance the care of this undertreated patient population.

Author Affiliations: From Thomson Reuters Inc (TLM), Washington, DC; Thomson Reuters Inc (LM), Cambridge, MA; University of Connecticut School of Medicine (HRK), Farmington, CT; Treatment Research Institute, Inc (MC), Philadelphia, PA; and Alkermes Inc (DRG), Waltham, MA.

 

Funding Source: This study was funded through a contract from Alkermes Inc to Thompson Reuters Inc. Dr Kranzler's involvement was supported by grant K24 AA013736 from the National Institute on Alcohol Abuse and Alcoholism.

 

Author Disclosures: Dr Kranzler reports serving as a paid consultant for Gilead Sciences and has received research grants from Merck & Co. Dr Gastfriend is an employee of Alkermes Inc and reports owning stock in the company. The other authors (TLM, LBM, MC) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. Authorship Information: Concept and design (TLM, LBM, HRK, MC, DRG); acquisition of data (TLM, LBM); analysis and interpretation of data (TLM, LBM, HRK, MC, DRG); drafting of the manuscript (TLM, LBM, HRK, MC, DRG); critical revision of the manuscript for important intellectual content (TLM, HRK, MC, DRG); statistical analysis (TLM); obtaining funding (TLM, LBM, DRG); administrative, technical, or logistic support (TLM, LBM); and supervision (TLM, DRG).

 

Address correspondence to: Tami L. Mark, PhD, Thomson Reuters Inc, 4301 Connecticut Ave NW, Ste 330, Washington, DC 20008. E-mail: tami. mark@thomsonreuters.com.

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