May 2010

Document Type


Degree Name



Dept. of Public Health and Preventive Medicine


Oregon Health & Science University


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.




School of Medicine



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.