OBJECTIVES: This study described the healthcare resource utilization (HRU) associated with extended-release naltrexone (XR-NTX) versus alternative treatments for opioid use disorder (OUD) among publicly insured patients.

METHODS: Adults (≥18 years) with OUD initiating XR-NTX, buprenorphine (BUP), methadone (MET), or non-pharmacological treatment (NPT) between 01/01/2011 and 12/31/2016 were identified using the MarketScan® Multi-State Medicaid database. The date of first treatment claim was defined as the index date. Differences in all-cause HRU between 12-months baseline (pre-index) and follow-up (post-index) periods were assessed for each treatment cohort. Proportion of days covered (PDC) with treatment was measured during follow-up.

RESULTS: Overall, 80,375 patients were included: XR-NTX (n=6,451), BUP (n=39,646), MET (n=12,985), and NPT (n=21,293). The XR-NTX cohort had higher baseline Elixhauser comorbidity scores versus other cohorts (mean ±SD XR-NTX 2.90±2.06 versus BUP 2.27±1.89, MET 2.01±1.91, and NPT 2.04±2.14; p<0.05 for XR-NTX versus each cohort). The XR-NTX cohort had the largest reduction in inpatient admissions from baseline to follow-up (-35%) versus other cohorts (BUP -5%, MET +21%, and NPT -12%). Outpatient visits and pharmacy fills increased for all cohorts from baseline to follow-up; however, the XR-NTX cohort had the smallest increase in outpatient visits (XR-NTX +49% versus BUP +206%, MET +334%, and NPT +266%) and pharmacy fills (XR-NTX +33% versus BUP +93%, MET +46% and NPT +40%). Baseline to follow-up changes in inpatient admissions, outpatient visits, and pharmacy fills for all cohorts were statistically significant (all p<0.05). PDC (mean ±SD) during follow-up was 0.44±0.26 in the XR-NTX cohort versus BUP (0.56±0.35) and MET (0.48±0.35) (p<0.05 for XR-NTX versus each cohort).

CONCLUSIONS: Despite higher baseline comorbidities, the XR-NTX cohort had the largest decrease in inpatient admissions and smallest increase in outpatient visits and pharmacy fills between baseline and follow-up versus other treatments. These results demonstrate potential economic value of XR-NTX for publicly insured patients with OUD.