Extended-release naltrexone for alcohol dependence: persistence and healthcare costs and utilization

Am J Manag Care. 2011 Jun;17 Suppl 8(Suppl 8):S222-34.


Objective: Evaluate persistence with treatment, healthcare costs, and utilization in stably enrolled Aetna Behavioral Health members receiving extended-release naltrexone (XR-NTX) for alcohol use dependence compared with oral medications and psychosocial therapy only.

Study design: Historical cohort study.

Methods: Aetna beneficiaries with stable enrollment (at least 6 months before and after index treatment) who initiated pharmacotherapy with XR-NTX (n = 211), disulfiram (n = 1043), oral naltrexone (n = 1408), acamprosate (n = 2479), or psychosocial therapy only (n = 6374) for alcohol use disorders between January 1, 2007, and December 31, 2008, were extracted and deidentified from Aetna's nationwide claims and utilization database. Survival analysis compared persistence with XR-NTX versus oral pharmacotherapies. Difference-in-differences analysis compared healthcare costs and utilization among patients receiving XR-NTX versus oral pharmacotherapies and psychosocial therapy only. Multivariate analyses controlled for demographics.

Results: Patients taking acamprosate and disulfiram were more likely to discontinue treatment than patients taking naltrexone, and patients given oral naltrexone were more likely to discontinue treatment than those given XR-NTX. Outpatient behavioral health treatment visits increased in all study groups. Nonpharmacy healthcare costs and utilization of inpatient and emergency services decreased in the XR-NTX group relative to other study groups.

Conclusion: Patients receiving XR-NTX persisted with treatment longer than patients receiving oral alcohol use-disorder medications or psychosocial therapy only, and had decreased inpatient and emergency healthcare costs and utilization compared with those receiving other medications.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Female
  • Health Care Costs / statistics & numerical data*
  • Health Services / statistics & numerical data*
  • Humans
  • Insurance Claim Review
  • Kaplan-Meier Estimate
  • Male
  • Multivariate Analysis
  • Naltrexone / economics
  • Naltrexone / pharmacokinetics
  • Naltrexone / pharmacology
  • Naltrexone / therapeutic use*
  • Narcotic Antagonists / economics
  • Narcotic Antagonists / pharmacokinetics
  • Narcotic Antagonists / pharmacology
  • Narcotic Antagonists / therapeutic use*
  • Proportional Hazards Models
  • Risk Factors
  • Time Factors
  • United States


  • Narcotic Antagonists
  • Naltrexone