Am J Manag Care. 2011 Jun;17 Suppl 8:S222-34.
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).
Retrospective claims database analysis.
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.
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.
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.
确定药物治疗与无药物治疗以及美国食品和药物管理局 (FDA) 批准的 4 种药物治疗酒精依赖的相关医疗费用。
回顾性索赔数据库分析。
从一家大型美国健康计划和 IMS PharMetrics 综合数据库中确定符合条件的酒精依赖成年人。数据包括所有医疗和药房索赔，涵盖所有可用医疗保健地点。使用倾向评分匹配和逆概率加权对 20752 名患者的基线人口统计学、临床和医疗保健利用变量进行了分析，其中一半患者使用了 FDA 批准的酒精依赖药物。对使用 FDA 批准的药物治疗的 15502 名患者进行了类似比较：口服钙双硫仑 (n = 8958)、口服双硫仑 (n = 3492)、盐酸纳曲酮 (n = 2391) 或长效纳曲酮注射剂 (XR-NTX; n = 661)。分析计算了以下 6 个月的治疗持续时间、利用率和支付索赔：酒精中毒药物、解毒和康复、与酒精相关和非相关的住院治疗、门诊服务和总费用。
药物治疗与各种类型的住院治疗次数减少有关。尽管药物治疗费用较高，但接受药物治疗的患者的总医疗保健费用（包括住院、门诊和药房费用）比接受酒精依赖药物治疗的患者低 30%。与任何口服药物相比，XR-NTX 与更高的续药率、更少的因任何原因住院和更低的住院费用相关。尽管 XR-NTX 本身的成本较高，但总医疗保健成本与口服纳曲酮或双硫仑无显著差异，比钙双硫仑低 34%。
在迄今为止最大的酒精药物治疗成本研究中，接受药物治疗的患者的医疗保健利用率和总费用低于未接受药物治疗的患者。与口服药物相比，XR-NTX 在治疗持续时间和医疗保健利用率方面具有优势，总成本可与之相媲美或更低。
