Date

May 2010

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Objective: Insurance claims data from Aetna Behavioral Health were collected to assess health care costs, utilization, and persistence with treatment among Aetna beneficiaries receiving XR-NTX for AUDs compared to those receiving (1) disulfiram, (2) oral NTX, (3) acamprosate, and (4) psychosocial therapy only. Methods: Aetna extracted patient-level data from their national claims and utilization database for Aetna beneficiaries receiving XR-NTX (n = 211), disulfiram (n = 1,043), oral NTX (n = 1,408), acamprosate (n = 2,479), or psychosocial therapy only (n = 6,374) for AUDs from 1/1/07 – 12/31/08. Survival analysis compared persistence with XR-NTX vs. oral pharmacotherapies over a six month period. Difference-in-differences analysis compared health care costs and utilization among those receiving XR-NTX vs. oral pharmacotherapies and psychosocial therapy only. Multivariate analyses controlled for demographics. Stratification over physical and mental health comorbidities accounted for interactions. Results: Patients taking acamprosate and disulfiram were more likely to discontinue treatment during the six month follow-up period than patients taking XR-NTX or oral NTX, and oral NTX patients were more likely to discontinue treatment than XR-NTX patients. Outpatient behavioral health utilization increased with treatment in all study groups. Non-pharmacy health care costs and utilization of inpatient and emergency services decreased in the XR-NTX group relative to other study groups, especially in patients with physical and mental health comorbidities. Conclusions: Naltrexone patients persisted with treatment longer than acamprosate and disulfiram patients, and XR-NTX longer than oral NTX. XR-NTX patients decreased non-pharmacy spending and utilization to a greater extent than comparison groups, and all groups increased outpatient behavioral health utilization. These trends were particularly strong in patients with comorbidities.

Identifier

doi:10.6083/M4DZ069Q

School

School of Medicine

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