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. 2024 Sep 26:18:29768357241280713.
doi: 10.1177/29768357241280713. eCollection 2024 Jan-Dec.

Treatment Journey and Healthcare Resource Use Among Patients With Alcohol Use Disorder Who Initiated Extended-Release Naltrexone: An Analysis of Veterans Affairs Data

Regina Grebla  1 , Jieruo Liu  1 , Amy K O'Sullivan  1 , Sherry Shi  2 , Elyse Swallow  3 , Angela Lax  3 , Maria A Sullivan  1   4 , Shuqian Liu  5   6 , Lizheng Shi  5   6 , Katie Witkiewitz  7 , Karen Drexler  8
Affiliations

Treatment Journey and Healthcare Resource Use Among Patients With Alcohol Use Disorder Who Initiated Extended-Release Naltrexone: An Analysis of Veterans Affairs Data

Regina Grebla et al. Subst Use. .

Abstract

Background: The US Department of Veterans Affairs, Department of Defense (VA/DoD) clinical guidelines recommend extended-release naltrexone (XR-NTX) as a treatment option for moderate-to-severe alcohol use disorder (AUD); however, contemporary real-world outcomes related to this guideline are lacking. This retrospective, observational, descriptive study examined treatment patterns and healthcare resource use (HCRU) among veterans with an AUD diagnosis who initiated XR-NTX.

Methods: Veterans with incident AUD who initiated XR-NTX between 8/2014 and 11/2018 were identified. Treatment patterns and HCRU were assessed during the 1-year baseline period before and following XR-NTX initiation (the index date).

Results: Of the 3665 VA patients (mean [SD] age: 46 [12.5] years; male: 89.7%; White: 76.9%) included in the study, time from AUD diagnosis to XR-NTX initiation was highly variable (mean [range]: 13.6 [0-50.5 months]). Patients received a mean [SD] of 6.8 [6.1] XR-NTX administrations; 44.4% received ⩾6. Mean [SD] time to XR-NTX discontinuation was 93.4 [75.7] days, and 31.3% of discontinuing patients resumed XR-NTX therapy. Of those who received other subsequent medications for AUD, 38.6% (acamprosate) to 47.8% (disulfiram) re-initiated XR-NTX. The proportion of patients with ⩾1 inpatient admissions decreased during follow-up compared with baseline (all-cause: 61.5% to 37.8%; AUD-related: 58.0%-35.4%); with a smaller decrease observed in emergency department (ED) visits. In contrast, more patients had ⩾1 outpatient visits during follow-up (all-cause: 97.5%-99.7%; AUD-related: 84.4%-92.7%). Compared with baseline, mean number of inpatient admissions and ED visits decreased during follow-up, while the number of outpatient visits increased for both all-cause and AUD-related care.

Conclusions: Among VA patients with AUD who initiated XR-NTX, we observed reductions in all-cause and AUD-related acute care, and increases in outpatient care. This finding demonstrates a possible transition from acute, inpatient treatment to long-term, outpatient care that may reflect a reduction in disease severity. Additional research is warranted.

Keywords: Veterans; alcohol use disorder; health economics; real-world evidence; treatment.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RG is an employee of Alkermes, Inc. JL, AKO and MAS and were employees of Alkermes, Inc., during the conduct of the study and may own stock in the company. SS, ES and AL are employees of Analysis Group, Inc., a consulting firm that received funding from the study’s sponsor to conduct this study. KW serves on the Scientific Advisory Board for Pear Therapeutics and is a member of the Alcohol Clinical Trials Initiative (ACTIVE) Workgroup, which has been supported previously, but not in the past 36 months, by Abbott/AbbVie, Amygdala Neurosciences, Arbor Pharmaceuticals, GSK, Indivior, Janssen, Lilly, Pfizer, and Schering Plough; but in the past 36 months, its activities were supported by Alkermes, Inc., Dicerna, Ethypharm, Lundbeck, Mitsubishi, and Otsuka. SL, LS and KD have no financial conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Study design. Abbreviations: AUD, alcohol use disorder; VHA, Veterans Health Administration; XR-NTX, extended-release naltrexone.
Figure 2.
Figure 2.
Patient disposition. Abbreviations: AUD, alcohol use disorder; OUD, opioid use disorder, VHA, Veterans Health Administration; XR-NTX, extended-release naltrexone. aUnlike other health claims databases, the Veterans Affairs Corporate Data Warehouse does not have an eligibility file. However, there is a variable for disenrollment. which was used to ensure patients are currently enrolled. bAs patients are automatically enrolled in the VHA upon return from military service, patients may or may not use the VHA services for their medical care. To identify patients with regular use of the VHA, we required at least 2 encounters during the baseline period.
Figure 3.
Figure 3.
AUD treatment initiations beyond the index XR-NTX injection, for up to 2 subsequent treatment initiations.a Abbreviations: AUD, alcohol use disorder; XR-NTX, extended-release naltrexone. aIndex XR-NTX was defined as patient’s first prescription for XR-NTX. In total, eight patients who died (n=5 with no further treatment, n=2 with oral naltrexone followed by no further treatment, and n=1 with XR-NTX + oral naltrexone followed by XR-NTX + acamprosate) within the year following index date are included in the figure.bPatients with no further treatment observed were followed through the end of follow-up, defined as the earliest date of disenrollment, death, or end of data.cAmong patients who took multiple treatments, the following were observed: XR-NTX + oral naltrexone (n=90), XR-NTX + disulfiram (n=29), oral naltrexone + disulfiram (n=22), XR-NTX + acamprosate (n=10), oral naltrexone + acamprosate (n=8), and acamprosate + disulfiram (n=2).dMultiple treatments include: XR-NTX + oral naltrexone (n=54), oral naltrexone + disulfiram (n=11), oral naltrexone + acamprosate (n=5), XR-NTX + acamprosate (n=2), XR-NTX + oral naltrexone + acamprosate (n=1), and XR-NTX + oral naltrexone + disulfiram (n=1). eMultiple treatments include: XR-NTX + acamprosate (n=6), oral naltrexone + acamprosate (n=3), XR-NTX + oral naltrexone (n=1), XR-NTX + disulfiram (n=1), oral naltrexone + disulfiram (n=1), and acamprosate + disulfiram (n=1).fMultiple treatments include: XR-NTX + disulfiram (n=14), oral naltrexone + disulfiram (n=3), XR-NTX + oral naltrexone (n=2), acamprosate + disulfiram (n=2), and XR-NTX + oral naltrexone + disulfiram (n=1). gMultiple treatments include: XR-NTX + disulfiram (n=2), XR-NTX + oral naltrexone + disulfiram (n=2), and XR-NTX + acamprosate (n=1).
Figure 4.
Figure 4.
Healthcare resource use during the 1-year period prior to and following the index date. (A) All-cause HCRU, any admission/visit. (B) AUD-related HCRU, any admission/visit. Abbreviations: AUD, alcohol use disorder; ED, emergency department; HCRU, healthcare resource use; MAUD, medication for alcohol use disorder; RTC, residential treatment center.
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