Improved Adherence Associated With MAUD Initiation Among Veterans

According to session presenters at the American Academy of Addiction Psychiatry’s 32^nd Annual Meeting and Scientific Symposium, the initiation of medications for alcohol use disorder (MAUD) has improved adherence and potentially lowered the cost of care for US veterans with alcohol dependence (AD).

Researchers conducted retrospective, observational study using data from the Veterans Health Administration’s (VHA) Corporate Data Warehouse. The primary goal of the study was to better understand patterns associated with MAUD initiation, measure health care resources utilization, and compare changes in adherence.

Inclusion criteria included veterans aged 18 years and older, with incident AD, who had no evidence of opioid use disorder. MAUDs initiated were either extended-release naltrexone, oral naltrexone, acamprosate, or disulfiram between August 2014 and November 2018. Baseline demographics, clinical characteristics, treatments, and resource utilization were assessed for the year prior to the index date—the date the first prescription MAUD was initiated.

According to the researchers, “12% of VHA patients with a diagnosis of AD received a MAUD during the study period.”

The final patient sample included 31,384 veterans who were primarily male, white, not employed, and were aged an average of 46 to 51 years depending on the MAUD received—extended-release naltrexone (1.4%), oral naltrexone (79.9%), acamprosate (12%), and disulfiram (6.7%). Across all MAUD subgroups, ≥50% of patients had major depressive disorder, ≥40% had post-traumatic stress disorder, and ≥30% had nicotine use disorder.

Per the results of the study, the average time to MAUD initiation for all patients groups was 8.4 months. However, patients in the extended-release naltrexone group averaged significantly higher proportions of days covered compared to the other subgroups demonstrating better adherence and more time on treatment.

“Among patients who discontinued initial treatment, 45.9% (extended-release naltrexone) to 53.6% (disulfiram) initiated subsequent MAUD treatment,” explained researchers. “The most frequent subsequent treatment was re-initiation of the initial MAUD.”

In terms of health care resource utilization, the researchers found that inpatient admissions were lower among all the MAUD subgroups at follow-up compared to their baseline. All cause admissions/visits showed a mean increase across all groups at follow up.

Overall, the researchers explained that the initiation of MAUD has the potentially to reduce costs of care and even strengthen patient engagement, which they note is an important prognostic indicator for improved, long-term outcomes in this specific patient population.

Reference:
Kauf TL, Liu J, O’Sullivan AK, et al. Treatment patterns and healthcare resource use among patients initiating medication for incident alcohol dependence: an analysis of veterans affairs data. Session at: AAAP’s 32nd Annual Meeting and Scientific Symposium; December 9-12, 2021; Virtual.