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Study in managed care journal backs cost-effectiveness of alcohol medications

January 27, 2011
by Gary A. Enos, Editor
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Vivitrol shows best results in reducing detox and hospital days

The makers of Vivitrol, the once-monthly injectable form of the medication naltrexone to treat alcohol dependence, believe results of a newly published study will take the addiction field’s acceptance of their product to a new level. Published in the December 2010 issue of The American Journal of Managed Care, the research appears to offer the best argument to date that using Vivitrol as part of alcohol dependence treatment can prove cost-effective.

“This is the number one journal in the field of managed care, and that’s medical managed care, not specialty,” says David Gastfriend, MD, vice president of medical affairs at Alkermes, Inc. and a co-author of the study. “It is unusual to get prominence for an addiction story in that journal.”

The study examined claims data from about 150 large self-insured employers and regional health plans. It compared healthcare utilization and costs associated with adults who received medication treatments for alcohol dependence to the same factors for those who received no medications as part of treatment. The analyzed groups of about 3,000 patients each were about 60 percent male, with an average age of 45.

The group receiving a medication was found to have a smaller percentage of detoxification admissions and fewer inpatient detox days at six months than the group not receiving a medication. In addition, the group receiving a medication had a smaller percentage of inpatient admissions for alcohol dependence, and fewer alcoholism-related visits to a hospital emergency room.

The researchers then looked at variations based on which of the four federally approved alcohol medications (disulfiram, naltrexone, acamprosate or the injectable extended-release naltrexone) the individuals received. They found that individuals receiving Vivitrol had fewer inpatient detox days than did those receiving oral naltrexone or acamprosate, and fewer alcoholism-related inpatient days than did the disulfiram and acamprosate groups.

The latter difference in inpatient hospitalization translated to substantially lower inpatient costs associated with Vivitrol per 1,000 patients ($382,460, vs. more than $1 million for both disulfiram and acamprosate). Gastfriend believes this finding should help counteract concerns in the field about the costs associated with administering the injectable medication.

“The addiction field needs to be educated on what is cost-effective treatment and what is cost-effective pharmacotherapy,” Gastfriend says. He adds that this study’s publication in a prominent managed care journal is already capturing the attention of those who make critical decisions about which medications are reimbursable in health plans.

“When pharmacy benefit managers read this, this is the kind of data they tend to want to see,” Gastfriend says.

He adds that it is not known exactly why Vivitrol stacked up favorably against the other medications in this analysis, although the opportunity for enhanced treatment compliance based on a monthly injection instead of daily dosing of oral medication could be one factor.

Gastfriend believes this research helps bolster treatment recommendations from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) that suggest that all patients with alcohol dependence should be considered for receiving both behavioral therapy and pharmacotherapy. “This now supports that standard of care,” he says.

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