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May 22, 2012

May 22, 2012. Medication Research Partnership Project. Research Team Roles. Coaching (facilitate adoption of medications, physician linkages, & change project problem solving) Dennis, Mady, Jack, Kelly, Kim, Jay. Qualitative Evaluation (Interviews to understand barriers & facilitators)

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May 22, 2012

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  1. May 22, 2012

  2. Medication Research Partnership Project Research Team Roles Coaching (facilitate adoption of medications, physician linkages, & change project problem solving) Dennis, Mady, Jack, Kelly, Kim, Jay Qualitative Evaluation (Interviews to understand barriers & facilitators) Laura, Raina, Kelly Quantitative Evaluation (Examine utilization & expenditure data to compare MAT effectiveness) All team members

  3. Medication Research Partnership Participation Timeline Periodic Coaching Calls

  4. Medication Research Partnership Who We Are MRP

  5. Medication-Assisted Treatment: Systematic Review and Meta-analysis of Utilization and Cost Studies Dennis McCarty, PhD Medication Research Partnership Learning Session 2 Philadelphia, PA May 22, 2012

  6. Disclosure and Aim • A research services agreement with Alkermes supported the analysis (the maker of Vivitrol) • A systematic review of utilization and cost of health care following pharmacotherapy • Mark et al. (2010) Am J Managed Care, 879 – 888. • Baser et al. (2011) Am J Managed Care, S222-S234. • Baser et al. (2011) Am J Managed Care, S235-S246. • Bryson et al. (2011) Am J Managed Care, S213-S221.

  7. Methods • Electronic literature search and abstract review • 16 potential studies • Four included XR-NTX and utilization and cost of care • A meta-analysis extracted data and estimated overall effects • medication vs. no medication • compared effects within patients using medication • Effect measured as standard mean difference

  8. Results • Patients using medication had lower healthcare utilization and cost of care • XR-NTX patients had more days of medication • Compared to other medications, XR-NTX was associated with • fewer detoxification days, • fewer alcohol and drug-related inpatient days • lower total costs of care

  9. Medication Versus No MedicationInpatient Substance Related DaysStandard Mean Difference

  10. XR-NTX versus Other Medications • Alcohol dependence: XR-NTX vs tablet NTX, disulfiram, acamprosate) • Basur: n=15,502; PharMetrics data • Bryson: n=5,141; Aetna Behavioral Health plan data • Mark: n=9,503; MarketScan data • Opioid dependence: XR-NTX vs tablet NTX, buprenorphine, methadone • Basur: n=10,513; PharMetrics data

  11. Number of Days with Medication Coverage Tablet Naltrexone Disulfiram Acamprosate

  12. Inpatient substance-abuse days* Tablet Naltrexone Disulfiram Acamprosate *Standardized Mean Difference

  13. Total Costs Tablet Naltrexone Disulfiram Acamprosate

  14. Discussion & Next Steps • Patients using medication appear to have fewer detox and inpatient admissions. • Total costs of care appear to be lower for patients using medication • XR-NTX was associated with greater savings • Limitations • Limited numbers of studies

  15. Acknowledgements • Daniel Hartung, Rochell Fu, Katharina Wiest, Mady Chalk, David Gastfriend • Supported through a research services agreement from Alkermes • Data presented at the 2012 American Psychiatric Association Annual Meeting

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