title: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Bryson
authors.forename: John
authors.initials: J
authors.lastname: McConnell
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
mesh_terms: D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D009271:Naltrexone / Q000191:economics / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000191:economics / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D014481:United States
chemical_list: D009292:Narcotic Antagonists; D009271:Naltrexone