# Presentation: 683794

## Medication Treatment of Alcohol Use Disorders in the Veterans Health Administration 

- Alex Harris, Dan Kivlahan, Thomas Bowe, Keith Humphreys
- QUERI Annual Meeting
- Phoenix AZ. Dec 10-12 2008

## This study was funded in part by the VA Office of Research and Development, Health Services Research and Development Service (MRP-05-168-1), the VA Program Evaluation and Resource Center. The views expressed herein are the authors’ not those of the Department of Veteran Affairs.

## The FDA has approved four pharmacological treatments for alcohol use disorders (AUD):

- Acamprosate (Campral)
- Naltrexone (Oral)
- Naltrexone IM (Vivitrol)
- Disulfiram (Antabuse)

## Goals

- Determine the extent to which these medications are utilized to treat the quarter million patients with AUDs in VA
-  Examine the patient characteristics and setting characteristics associated with receipt of these medications.

## Methods

-  Using VHA pharmacy (DSS) and administrative data, we identified patients with AUD diagnoses (303.xx or 305.xx) in FY06 and FY07 and determined what proportion had filled a prescription for each and any of the four medications
- Does not include patients without AUD diagnoses receiving the drugs

## Slide 6

|  | FY 2006 | FY 2007 | Change |
| --- | --- | --- | --- |
| Total AUD Outpatient | 252,884 | 267,117
 | 5.63% |
| Total AUD Inpatient/
Residential | 58,450 | 58,677 | 0.38% |
| Total AUD Unique | 267,982 | 281,353 | 4.98% |

## Slide 7

| Campral | FY 2006 | FY 2007 | Change |
| --- | --- | --- | --- |
| Unique AUD Outpatients  | 990 (0.39%)  | 1290 (0.48%) | 0.09%  |
| Unique AUD Inpatients  | 627 (1.07%)  | 617 (1.05%)  |  -0.02%  |
| Unique AUD Patients  | 1330 (0.49%) | 1594 (0.56%)  | 0.07%  |
| Average fills per patient  | 4.13  | 4.15 | 0.02 fills/pt  |

## Slide 8

| Naltrexone (oral) | FY 2006 | FY 2007 | Change |
| --- | --- | --- | --- |
| Unique AUD Outpatients  | 3000 (1.19%)	  | 3709 (1.39%)  | 0.20%  |
| Unique AUD Inpatients  | 1306 (2.23%)  | 1594 (2.71%)  | 0.48%  |
| Unique AUD Patients  | 3658 (1.37%)  | 4524 (1.60%)  |  0.23%  |
| Average fills per patient  | 4.04  | 4.03 | -.01 fills/pt |

## Slide 9

| Naltrexone IM | FY 2006 | FY 2007 | Change |
| --- | --- | --- | --- |
| Unique AUD Outpatients  | 0	  | 39 (<0.01%)  | 0.20%  |
| Unique AUD Inpatients  | 0  | 40 (<0.01%)  | 0.48%  |
| Unique AUD Patients  | 0  | 70 (<0.01%)  |  0.23%  |
| Average fills per patient  | 0 | 2.02  | -.01 fills/pt |

## Slide 10

| Antabuse | FY 2006 | FY 2007 | Change |
| --- | --- | --- | --- |
| Unique AUD Outpatients  | 2721 (1.08%)  | 2643 (0.99%)  | -0.09%  |
| Unique AUD Inpatients  | 887 
(1.50%)  | 915 (1.55%)  | 0.05%  |
| Unique AUD Patients  | 3111 (1.16%)  | 3086 (1.09%)  | -0.07%  |
| Average fills per patient  | 4.59  | 4.41  | -0.18 fills/pt  |

## Slide 11

| Any AUD Medication | FY 2006 | FY 2007 | Change |
| --- | --- | --- | --- |
| Unique AUD Outpatients  | 6310 (2.50%)  | 7172 (2.68%)  | 0.18% |
| Unique AUD Inpatients  | 2609 (4.46%)  | 2864 (4.88%)  | 0.42%  |
| Unique AUD Patients  | 7520 (2.82%)  | 8502 (3.04%)  | 0.22% |
|  |  |  |  |

## Slide 12

## Slide 13

## Conclusion

- About 3% of VA patients with AUDs were treated with medications in FY06 and FY07.
- These data suggest and opportunity for implementation efforts and provide a useful benchmark to track increased use of these medications.