Pmh13 Characteristics and Cost Outcomes of Insured Patients Treated With Extended-Release Naltrexone (Xr-Ntx) or Oral Alcohol Dependence Medications

Mark, T. M. van der; Gastfriend,; Hr, Kranzler; Chalk, Mady; Montejano, Leslie

doi:10.1016/s1098-3015(10)72509-2

Cited by 3 publications

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“…Past research studies have called for a rigorous cost-effectiveness analysis of XR-NTX and primary care MM compared to oral naltrexone, since XR-NTX is substantially more expensive than O-NTX (~$1100 vs. ~$100 per month) [40]. A study commissioned by Alkermes, the manufacturer of XR-NTX, showed that XR-NTX could be more economically effective compared to O-NTX, based off of reduced usage of expensive emergency and detox services [41]. We are attempting to independently and more rigorously examine these cost issues using a prospective randomized design, which includes long-term outcomes one year after beginning treatment.…”

Section: Discussionmentioning

confidence: 99%

Extended-release vs. oral naltrexone for alcohol dependence treatment in primary care (XON)

Malone

McDonald

Vittitow

et al. 2019

Contemporary Clinical Trials

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Background: Extended-release naltrexone (XR-NTX, Vivitrol®) and daily oral naltrexone tablets (O-NTX) are FDA-approved mu opioid receptor antagonist medications for alcohol dependence treatment. Despite the efficacy of O-NTX, non-adherence and poor treatment retention have limited its adoption into primary care. XR-NTX is a once-a-month injectable formulation that offers a potentially more effective treatment option in reducing alcohol consumption and heavy drinking episodes among persons with alcohol use disorders. Methods: This pragmatic, open-label, randomized controlled trial examines the effectiveness of XR-NTX vs. ONTX in producing a Good Clinical Outcome, defined as abstinence or moderate drinking (< 2 drinks/day, men; < 1 drink/day, women; and < 2 heavy drinking occasions/month) during the final 20 of 24 weeks of primary care-based Medical Management treatment for alcohol dependence. Secondary aims will estimate the cost effectiveness of XR-NTX vs. O-NTX, in conjunction with primary-care based Medical Management for both groups, and patient-level characteristics associated with effectiveness in both arms. Alcohol dependent persons are recruited from the community into treatment in a New York City public hospital primary care setting (Bellevue Hospital Center) for 24 weeks of either XR-NTX (n = 117) or O-NTX (n = 120). Results: We describe the rationale, specific aims, design, and recruitment results to date. Alternative design considerations and secondary aims and outcomes are reported. Conclusions: XR-NTX treatment in a primary care setting is potentially more efficacious, feasible, and cost-effective than oral naltrexone when treating community-dwelling persons with alcohol use disorders. This study will estimate XR-NTX’s treatment and cost effectiveness relative to oral naltrexone.

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Section: Discussionmentioning

confidence: 99%

Extended-release vs. oral naltrexone for alcohol dependence treatment in primary care (XON)

Malone

McDonald

Vittitow

et al. 2019

Contemporary Clinical Trials

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“…Compared to the baseline period, XR-NTX was associated with increased utilization of outpatient counseling in the Aetna Behavioral Health sample 105 and in the Medstat Marketscan database analysis, across multiple insurers, a significantly greater percentage of patients on XR-NTX (68.6%) had an outpatient visit for substance abuse treatment than patients on oral agents (38.0% oral naltrexone, 40.2% disulfiram, 40.1% acamprosate; P < 0.001). 104 Thus, in both a randomized, controlled efficacy trial, and in naturalistic insurance database analyses, the evidence does not indicate that XR-NTX interferes with or is incompatible with participation in psychosocial management.…”

Section: Use Of Xr-ntx and Psychosocial Counseling And Self-help Attementioning

confidence: 99%

“… Retrospective insurance claims analysis with propensity score matching: Four‐way comparison of intensive health care utilization for the 6‐month period following an index medication dose, showing greater reduction in detoxification days per 1,000 patients for XR‐NTX vs. disulfiram ( P = 0.049), oral naltrexone ( P = .003), and acamprosate ( P < 0.001), and greater reduction in alcohol‐related hospital days per 1,000 patients for XR‐NTX vs. disulfiram ( P = 0.004), oral naltrexone ( P = NS), and acamprosate ( P < 0.001)(adapted from Ref. 104). …”

Section: Health Economic Studies Of Xr‐ntxmentioning

confidence: 99%

“…A larger study using a different commercial insurer claim database has looked at the healthcare utilization and costs associated with alcoholdependence pharmacotherapy. 104 Using propensity score matching on demographic and baseline clinical and healthcare utilization variables, alcohol-dependent patients who had received an FDA-approved medication for alcohol dependence (n = 2,977) were compared with those who had not received such medication (n = 2,977) on 6-month healthcare utilization rates. In addition, comparisons were made among those who received oral naltrexone (n = 663), disulfiram (n = 2,076), acamprosate (n = 883), or XR-NTX (n = 295).…”

Section: Use Of Xr-ntx In Driving Under the Influence (Dui) And Drug mentioning

confidence: 99%

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Intramuscular extended‐release naltrexone: current evidence

Gastfriend

2011

Annals of the New York Academy of Sciences

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Extended-release naltrexone (XR-NTX; Vivitrol), developed to address poor adherence in addictive disorders, is approved for use in alcohol and opioid-dependence disorders. In alcohol-dependent adults with ≥ 4-day initial abstinence, XR-NTX increased initial and 6-month abstinence. An fMRI study found that XR-NTX attenuated the salience of alcohol visual and olfactory cues in the absence of alcohol, and post hoc analyses demonstrated efficacy even during high cue-exposure holiday periods. Safety and tolerability have generally been good, without adverse hepatic impact or intractable acute pain management. XR-NTX use appears feasible in primary care and public systems, and retrospective claims analyses have found cost savings and decreased intensive service utilization relative to oral agents. In opioid dependence, following detoxification, XR-NTX shows efficacy for maintaining abstinence, improving retention, decreasing craving, and preventing relapse. Trials are also exploring its use for the treatment of stimulant dependence. XR-NTX appears compatible with counseling and self-help attendance. While more research is needed, current findings suggest that a formulation of naltrexone that was sought beginning over three decades ago is fulfilling its promise as an extended-release pharmacotherapeutic.

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Impact of hospital‐administered extended‐release naltrexone on readmission rates for patients with alcohol use disorder

Singh,

Daniel,

Balasanova

2024

Internal Medicine Journal

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Background and AimsAlcohol use disorder (AUD) is a persistent public health concern, contributing significantly to mortality and morbidity. This study aims to evaluate the impact of in‐hospital extended‐release naltrexone (XR‐NTX) administration on alcohol‐related outcomes.MethodsThis retrospective cohort study, conducted at an academic medical centre, included 141 adult patients with AUD who received XR‐NTX between December 2020 and June 2021. Primary and secondary outcomes were assessed 90 days before and after XR‐NTX administration to identify number of alcohol‐related hospitalisations, emergency department (ED) visits and average length of hospital stay. Subgroup analyses assessed outcomes in high hospital utilisers and marginally housed or unhoused populations.ResultsThere was a significant decrease in ED visits and length of hospital stay post XR‐NTX and no significant difference in the number of rehospitalisations. Subgroup analysis showed significant reduction in hospital readmissions and ED visits among high hospital utilisers. Our sample was a predominantly middle‐aged, male and white patient population.ConclusionsIn‐hospital initiation of XR‐NTX for AUD was associated with a significant decrease in ED visits and length of hospital stay. While no significant impact on the number of hospitalisations was observed overall, there was a substantial reduction in hospital readmissions and ED visits among high utilisers. Our findings suggest the potential benefits of in‐hospital XR‐NTX, emphasising the need for further research to establish causal relationships, assess cost‐effectiveness and explore effectiveness across diverse patient populations. Effective in‐hospital interventions, such as XR‐NTX, hold promise for improving patient outcomes and reducing the healthcare burden associated with AUD.

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Pmh13 Characteristics and Cost Outcomes of Insured Patients Treated With Extended-Release Naltrexone (Xr-Ntx) or Oral Alcohol Dependence Medications

Cited by 3 publications

References 0 publications

Extended-release vs. oral naltrexone for alcohol dependence treatment in primary care (XON)

Extended-release vs. oral naltrexone for alcohol dependence treatment in primary care (XON)

Intramuscular extended‐release naltrexone: current evidence

Impact of hospital‐administered extended‐release naltrexone on readmission rates for patients with alcohol use disorder

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