Extended-release naltrexone for alcohol dependence: persistence and healthcare costs and utilization

Abstract

Objective: Evaluate persistence with treatment, healthcare costs, and utilization in stably enrolled Aetna Behavioral Health members receiving extended-release naltrexone (XR-NTX) for alcohol use dependence compared with oral medications and psychosocial therapy only.

Study design: Historical cohort study.

Methods: Aetna beneficiaries with stable enrollment (at least 6 months before and after index treatment) who initiated pharmacotherapy with XR-NTX (n = 211), disulfiram (n = 1043), oral naltrexone (n = 1408), acamprosate (n = 2479), or psychosocial therapy only (n = 6374) for alcohol use disorders between January 1, 2007, and December 31, 2008, were extracted and deidentified from Aetna's nationwide claims and utilization database. Survival analysis compared persistence with XR-NTX versus oral pharmacotherapies. Difference-in-differences analysis compared healthcare costs and utilization among patients receiving XR-NTX versus oral pharmacotherapies and psychosocial therapy only. Multivariate analyses controlled for demographics.

Results: Patients taking acamprosate and disulfiram were more likely to discontinue treatment than patients taking naltrexone, and patients given oral naltrexone were more likely to discontinue treatment than those given XR-NTX. Outpatient behavioral health treatment visits increased in all study groups. Nonpharmacy healthcare costs and utilization of inpatient and emergency services decreased in the XR-NTX group relative to other study groups.

Conclusion: Patients receiving XR-NTX persisted with treatment longer than patients receiving oral alcohol use-disorder medications or psychosocial therapy only, and had decreased inpatient and emergency healthcare costs and utilization compared with those receiving other medications.

Conflict of interest statement

Author Disclosures

There are no additional potential conflicts of interest.

Figures

Figure 1

Persistence with Medication over Time a a Survival curves are adjusted for demographics (gender, age, region, beneficiary status, plan type), pre-treatment physical health comorbidities (Charlson score), pre-treatment drug abuse comorbidities, and pre-treatment mental health comorbidities (schizophrenia, bipolar, major depression, anxiety).

Figure 2

Utilization and Costs of Health Care Services a,b a Difference-in-Differences method with two-part model was employed. Logistic (part 1) and linear (part 2) regressions modeled cost and utilization outcomes with predictor variables representing demographics (gender, age, region, beneficiary status, plan type), study group, time relative to index date, and the study group*time interaction. b Figures 2A and 2B depict the difference-in-differences estimates that compare the effect of XR-NTX on health care costs and utilization to oral pharmacotherapies and psychosocial therapy only. Each bar represents the post- vs. pre-treatment difference in average utilization/costs in the XR-NTX group relative to the specified comparison group. Positive bars indicate that patients receiving XR-NTX increased their average utilization/costs in the 6-month post-treatment period relative to the comparison group. Negative bars indicate a relative decrease in utilization/costs in the XR-NTX group following treatment relative to comparison groups. The magnitude of the bars indicates the amount of relative increase/decrease in units of average utilization/cost per patient per six months. All comparisons are absolute differences (as opposed to ratios). * p