title: Alcohol dependence treatments: comprehensive healthcare costs, utilization outcomes, and pharmacotherapy persistence.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.forename: Onur
authors.initials: O
authors.lastname: Baser
authors.forename: Mady
authors.initials: M
authors.lastname: Chalk
authors.forename: Richard
authors.initials: R
authors.lastname: Rawson
authors.forename: David R
authors.initials: DR
authors.lastname: Gastfriend
mesh_terms: D000077443:Acamprosate; D000328:Adult; D000427:Alcohol Deterrents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D000437:Alcoholism / Q000188:drug therapy / Q000191:economics*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D004221:Disulfiram / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009271:Naltrexone / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D057216:Propensity Score; D012189:Retrospective Studies; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013654:Taurine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
chemical_list: D000427:Alcohol Deterrents; D009292:Narcotic Antagonists; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate; D004221:Disulfiram