title: Comparison of healthcare utilization among patients treated with alcoholism medications.
abstract: OBJECTIVE
  To determine in a large claims database the healthcare utilization and costs associated with treatment of alcohol dependence with medications vs no medication and across 4 US Food and Drug Administration (FDA)-approved medications.
  
  
  METHODS
  Claims database analysis.
  
  
  METHODS
  Eligible adults with alcohol dependence claims (n = 27,135) were identified in a commercial database (MarketScan; Thomson Reuters Inc, Chicago, Illinois). Following propensity score-based matching and inverse probability weighting on demographic, clinical, and healthcare utilization variables, patients who had used an FDA-approved medication for alcohol dependence (n = 2977)were compared with patients who had not (n =2977). Patients treated with oral naltrexone hydrochloride(n = 2064), oral disulfiram (n = 2076), oral acamprosate calcium (n = 5068), or extended-release injectable naltrexone (naltrexone XR) (n = 295) were also compared for 6-month utilization rates of alcoholism medication, inpatient detoxification days, alcoholism-related inpatient days, and outpatient services, as well as inpatient charges.
  
  
  RESULTS
  Patients who received alcoholism medications had fewer inpatient detoxification days (706 vs 1163 days per 1000 patients, P <.001), alcoholism-related inpatient days (650 vs 1086 days, P <.001), and alcoholism-related emergency department visits (127 vs 171, P = .005). Among 4 medications, the use of naltrexone XR was associated with fewer inpatient detoxification days (224 days per 1000 patients) than the use of oral naltrexone (552 days, P = .001), disulfiram (403 days, P = .049), or acamprosate (525 days, P <.001). The group receiving naltrexone XR also had fewer alcoholism-related inpatient days than the groups receiving disulfiram or acamprosate. More patients in the naltrexone XR group had an outpatient substance abuse visit compared with patients in the oral alcoholism medication groups.
  
  
  CONCLUSIONS
  Patients who received an alcoholism medication had lower healthcare utilization than patients who did not. Naltrexone XR showed an advantage over oral medications in healthcare utilization and costs.
authors.affiliation: Thomson Reuters Inc, 4301 Connecticut Ave NW, Ste 330, Washington, DC 20008, USA. tami.mark@thomsonreuters.com
authors.forename: Tami L
authors.initials: TL
authors.lastname: Mark
authors.forename: Leslie B
authors.initials: LB
authors.lastname: Montejano
authors.forename: Henry R
authors.initials: HR
authors.lastname: Kranzler
authors.forename: Mady
authors.initials: M
authors.lastname: Chalk
authors.forename: David R
authors.initials: DR
authors.lastname: Gastfriend
mesh_terms: D000077443:Acamprosate; D000427:Alcohol Deterrents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D000437:Alcoholism / Q000188:drug therapy* / Q000191:economics*; D003692:Delayed-Action Preparations; D004221:Disulfiram / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006801:Humans; D007297:Inpatients; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D009294:Narcotics / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D057216:Propensity Score; D012189:Retrospective Studies; D013654:Taurine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D014481:United States
chemical_list: D000427:Alcohol Deterrents; D003692:Delayed-Action Preparations; D009294:Narcotics; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate; D004221:Disulfiram