title: Persistence with oral naltrexone for alcohol treatment: implications for health-care utilization.
abstract: OBJECTIVE
  Concerns have been raised about patients' failure to persist in alcohol treatment. We examined prescriptions for oral naltrexone in a large, nationally distributed treatment population to identify characteristics and health-care utilization patterns associated with persistence.
  
  
  METHODS
  Data from the 2000-2004 MarketScan Commercial Claims and Encounters Database were used to identify patients with alcohol-related claims who were prescribed naltrexone.
  
  
  METHODS
  Analysis identified patient characteristics that predicted persistence with naltrexone (defined as having filled prescriptions for >or=80% of the 6-month treatment period) and its association to health-care utilization.
  
  
  RESULTS
  Of 1138 patients, 162 (14.2%) were persistent in obtaining naltrexone. Non-persistent patients were significantly younger, more likely to be hourly employees and to live in an area with a lower median income, and less likely to be newly diagnosed with an alcohol-related disorder. Non-persistence in obtaining naltrexone was associated with significantly more intensive treatments, including inpatient detoxification, emergency room visits and hospitalizations.
  
  
  CONCLUSIONS
  Over a 6-month period, 85.8% of patients who filled an initial prescription for naltrexone did not persist in obtaining the medication. Non-persistence was associated with significantly greater use of costly health-care services. Because the study was correlational, it is not possible to conclude that persistence reduced health-care costs, as patients with a better prognosis may have been more persistent. Research is needed to determine whether interventions that enhance persistence with naltrexone therapy improve treatment outcomes and reduce health-care costs.
authors.affiliation: Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030-2103, USA. kranzler@psychiatry.uchc.edu
authors.forename: Henry R
authors.initials: HR
authors.lastname: Kranzler
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Stephenson
authors.forename: Leslie
authors.initials: L
authors.lastname: Montejano
authors.forename: Shaohung
authors.initials: S
authors.lastname: Wang
authors.forename: David R
authors.initials: DR
authors.lastname: Gastfriend
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000188:drug therapy* / Q000191:economics; D000437:Alcoholism / Q000188:drug therapy* / Q000191:economics; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004739:England; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009271:Naltrexone / Q000191:economics / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone