Gender Disparities in Alcohol Use Disorder Treatment Among Privately Insured Patients with Alcohol‐Associated Cirrhosis

Abstract

Background: The burden of alcohol-associated cirrhosis (AC) is high, and though alcohol cessation improves mortality, many patients fail to engage in alcohol use disorder (AUD) treatment and continue drinking. Our aim was to determine rates, predictors, and outcomes of AUD treatment utilization in AC patients with private insurance. Methods: We collected data from persons with AC (diagnosed by ICD-9/ICD-10 codes), aged 18 to 64 years, enrolled in the Truven MarketScan Commercial Claims and Encounters database (2009 to 2016). We determined rates and predictors of substance abuse treatment visits as well as rates of alcohol relapse prevention medication prescriptions, weighted to the national employer-sponsored insured population. Effects of AUD treatment utilization on decompensation rates were calculated using proportional hazards regression with propensity score adjustment. Results: A total of 66,053 AC patients were identified, 32% were female, and mean age at diagnosis was 54.5 years. About 72% had insurance coverage for substance abuse treatment. Overall, AUD treatment utilization rates were low, with only 10% receiving a face-to-face mental health or substance abuse visit and only 0.8% receiving a Food and Drug Administration (FDA)-approved relapse prevention medication within 1 year of index diagnosis. Women were less likely to receive a face-to-face visit (hazard ratio [HR] 0.84, p < 0.001) or an FDA-approved relapse prevention medication (0.89, p = 0.05) than men. AC patients who had a clinic visit for AUD treatment or used FDA-approved relapse medication showed decreased risk of decompensation at 1 year (HR 0.85, p < 0.001 for either). Conclusions: AUD treatment utilization is associated with lower decompensation rates among privately insured patients with AC. Women were less likely to utilize AUD treatment visits. Efforts to reduce gender-specific barriers to treatment are urgently needed to improve outcomes.

Cost-effectiveness of alcohol use treatments in patients with alcohol-related cirrhosis

“…To estimate treatment effects, we relied on the unpublished corrected results of a retrospective cohort study that compared the rate of decompensation between AC patients who received different alcohol use treatments versus AC patients who did not receive an intervention. [14] The resulting relative risks, which are similar to those reported in a more recent study [15], were used as a model inputs ( Table 1). While our treatment effectiveness estimates are based on observational, real-world data, we do use a large sample of AC patients with employersponsored insurance followed over time, and our estimates reflect real-life effectiveness of alcohol use treatments in the AC population.…”

“…We grouped FDA-and non-FDAapproved MATs together because estimates of the effectiveness of these drugs on the AC population combined them into these categories due to low rates of overall use of these medications, particularly in the US. [14,15] All interventions are assumed to be provided over weeks. We assumed that patients in all four scenarios are receiving medical treatment for their ALD.…”

“…[11,12] Thus, optimal treatment of patients with co-occurring AUD and ALD remains to be defined and is often locally determined. [13] Recent observational studies, however, have shown that AC patients who received MATs or counseling exhibit marked reductions in the rate of decompensation [14,15], a key clinical objective in the treatment of ALD. Unfortunately, fewer than 10% of patients with AC receive either counselling or MAT at one year after their diagnosis, and these interventions are frequently poorly reimbursed.…”

“…Unfortunately, fewer than 10% of patients with AC receive either counselling or MAT at one year after their diagnosis, and these interventions are frequently poorly reimbursed. [14] Increased use of alcohol use treatments among AC patients is likely to be a good investment because of the significant costs that AC and its complications exact on healthcare systems, patients and their families, and society at large. To explore the value of these interventions on the compensated AC patient population, we conducted a cost-effectiveness analysis (CEA) comparing MATs and counseling with each other and to a do-nothing approach.…”

Integrated Treatment of Alcohol Use Disorder in Patients With Alcohol‐Associated Liver Disease: An Evolving Story

“…( 8 ) In another study, Mellinger et al examined an insurance‐based U.S. cohort of 66,053 individuals with alcohol‐associated cirrhosis, and discovered that only 10% received a face‐to‐face mental health or substance abuse visit, with only 0.8% receiving U.S. Food and Drug Administration–approved medication for AUD within 1 year of index diagnosis. ( 9 ) These data are particularly disappointing given that 72% of the cohort had specific coverage for treatment of substance abuse disorders.…”