Treatment Journey and Healthcare Resource Use Among Patients With Alcohol Use Disorder Who Initiated Extended-Release Naltrexone: An Analysis of Veterans Affairs Data
Substance Use: Research and Treatment, 2024
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.
Authors
Grebla R, Liu J, O'Sullivan AK, Shi S, Elyse Swallow E, Lax A, Sullivan MA, Liu S, Shi L, Witkiewitz K, Drexler K