TOPLINE:

Among patients with alcohol use disorder, medication use was linked to a lower likelihood of alcohol‑associated hospitalizations and lower mean charges than no medication use. Among patients with liver disease, pharmacotherapy for alcohol use disorder was consistently linked to lower hospitalization rates and mean inpatient charges across all severity levels.

METHODOLOGY:

• Alcohol use disorder imposes substantial health and economic burdens in the US; randomized trials and meta-analyses have demonstrated the efficacy of pharmacotherapy in reducing alcohol consumption and return to alcohol use, but real-world evidence on healthcare utilization and costs is limited.
• Researchers conducted a retrospective cohort study using administrative claims data from Optum’s Clinformatics Data Mart database in the US to assess the real-world impact of pharmacologic treatment for alcohol use disorder on alcohol-related healthcare utilization and costs.
• They included 601,497 individuals aged 21 years or older with a first diagnosis of alcohol use disorder, identified using diagnostic codes for alcohol abuse, alcohol dependence, and unspecified alcohol use, from 2017 to 2023.
• Participants were classified as treated if they initiated one or more medications for alcohol use disorder (MAUD) within 1 year of diagnosis with a supply of at least 30 days or as untreated if they did not receive any MAUD within a year. A total of 109,130 matched pairs (58.6% male; 63.9% White individuals) were identified using two-step propensity score matching.
• The primary outcomes were alcohol‑associated emergency department (ED) visits, inpatient admissions, and total alcohol-associated medical charges over 12 months; alcohol‑associated encounters and comorbidities were identified via diagnostic codes.

TAKEAWAY:

• Among treated patients, 16.2% received only on-label MAUD, 73.4% received only off-label MAUD, and 10.4% received both types. Gabapentin was the most frequently dispensed MAUD (62.5%); other medications included naltrexone, ondansetron, baclofen, topiramate, acamprosate, disulfiram, and varenicline.
• MAUD use was associated with lower total alcohol‑associated mean charges than no treatment ($47,696.8 vs $50,403.4; P < .001). ED charges and the proportion of patients with any ED visit were similar between treated and untreated patients.
• MAUD use was associated with significantly lower alcohol‑associated inpatient hospitalization rates (37.6% vs 41.4%) and lower mean inpatient charges ($39,055.2 vs $43,630.6) than no treatment. The largest differences were observed in patients with moderate-to-severe liver disease, among whom MAUD was associated with nearly $27,000 lower mean inpatient charges ($103,255 vs $130,068) and a lower hospitalization rate (59.4% vs 68.5%) than no treatment.
• MAUD exposure was linked to nearly 79% lower alcohol-associated charges than no treatment, whereas diagnosis in the ED or inpatient settings was associated with higher charges than outpatient diagnosis.

IN PRACTICE:

“[The findings suggest] that increasing access to and adoption of AUD [alcohol use disorder] pharmacotherapy could be a crucial strategy for healthcare systems to lower the financial burden related to management of AUD and ALD [alcohol-associated liver disease],” the authors of the study wrote. “These findings provide strong evidence supporting the broader implementation and increased utilization of AUD pharmacotherapy in patients with AUD, including in patients with advanced ALD, as a vital strategy to improve patient outcomes and alleviate the considerable economic burden of AUD,” they added.

SOURCE:

The study was led by Chi M. Nguyen, PhD, Indiana University School of Medicine, Indianapolis, and Hanna L. Blaney, MD, Virginia Commonwealth University, Richmond, Virginia. It was published online in Hepatology.

LIMITATIONS:

Administrative claims data were prone to coding errors and lacked detailed clinical information. Residual confounding from unmeasured factors, such as socioeconomic status and patient motivation, likely persisted despite propensity score matching. Prescription fills may not have accurately reflected actual medication adherence, and pharmacy claims lacked details regarding prescriber specialty or place of service. The 1-year follow-up captured short-term cost-effectiveness but may have underestimated longer-term benefits.

DISCLOSURES:

The study received support from National Institutes of Health grants, Department of Veterans Affairs Merit Awards, a Dean’s Scholar in Medical Research, and AnalytiXIN. One author disclosed owning stock ownership in Pfizer and Lilly; two authors reported consulting, and one of them also reported receiving research grants from various sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.