15 - Impact of Pharmacologic Treatment for Alcohol Use Disorder on Mortality in Patients with Alcohol-Associated Liver Disease: Analysis From a United States Insurance Claims Database

Monday, October 23, 2023

2:15 PM - 2:25 PM PT

Location: Ballroom B

Presenting Author(s)

EH

Elizabeth Harris, MD

University of Kentucky
Lexington, KY

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Elizabeth Harris, MD, Christian Rhudy, PharmD, MBA, Anthony A. Mangino, PhD, Christina Leyson, MD
University of Kentucky, Lexington, KY

Introduction: Mortality from alcohol and specifically alcohol-associated liver disease (ALD) has increased dramatically over the past two decades in the United States. However, studies show that many individuals with ALD do not receive any treatment for the alcohol use disorder (AUD) underlying their ALD. Using a large private insurance claims database, we aim to evaluate the association of AUD treatment medications with clinical outcomes in ALD.

Methods: This was a retrospective cohort study. Beneficiaries in a large nationwide commercial insurance claims and Medicare supplemental database with an index inpatient encounter associated with an ICD-9-CM or ICD-10-CM code for ALD between 1/1/2009 and 6/30/2019 were included. Beneficiaries were classified into cohorts based upon post-index encounter exposure to AUD medications (naltrexone, acamprosate, gabapentin, topiramate, disulfiram, or baclofen). Beneficiaries were excluded if they had pre-index exposure to AUD medications in the preceding 180 days. Beneficiary data was collected post-index until a gap of 30 days in enrollment, mortality, or the end of available data (6/30/2020). Beneficiaries with post-index exposure to AUD medications were then propensity matched 1:1 to beneficiaries without exposure based upon on age, index CCI, Commercial or Medicare payors, and index diagnoses of alcoholic cirrhosis, alcoholic hepatitis diagnosis, hepatic encephalopathy, and end-stage renal disease.

Results: 44,043 beneficiaries met inclusion criteria and 1,988 with pre-index AUD medication exposure were excluded. 2,825 beneficiaries had a post-index encounter AUD medication prescription and were matched 1:1 to a control cohort who did not. For those who received post-index AUD medication, 67.5% received gabapentin, 22.1% received naltrexone, 19.4% received acamprosate, 10.7% received baclofen, 8.5% received disulfiram, 6.4% received topiramate, and 26.2% received multiple medications. Mortality was 6.5% for those who did not receive an AUD medication prescription and 2.1% for those who did (p < 0.001).

Discussion: We found that patients who received a prescription for a medication to treat AUD after a hospital encounter for ALD had reduced mortality. This association suggests that patients with ALD benefit from recognition of their AUD as a medical problem that also needs treatment. Further studies are warranted to address whether instituting AUD treatment as part of standard of care management of ALD can improve outcomes for this worsening healthcare problem.

Figure: Figure 1. Alcohol use disorder medication prescribed post-index encounter

	Cohort that received prescription for alcohol use disorder medication post-index encounter (n=2,825)	Control cohort (no alcohol use disorder medication) (n=2,825)	P-value
Average birth year	1960	1960	1
% Female	35.1%	31.4%	0.004
% Medicare insurance	8%	8%	1
% Commercial insurance	68.1%	68.1%	1
Average Charlson comorbidity index	3.61	3.61	1
% Cirrhosis	49.9%	49.9%	1
% Hepatitis	58.9%	58.9%	1
% End-stage renal disease	0.3%	0.3%	1
% Hepatic encephalopathy	13.4%	13.4%	1
Post-index encounter mortality	2.1%	6.5%	0.001
Post-index encounter alcohol use disorder	81%	61%	0.001
Post-index encounter psychiatric disorder	75%	53%	0.001

Table: Table 1. Baseline characteristics and post-encounter outcomes

Disclosures:

Elizabeth Harris indicated no relevant financial relationships.

Christian Rhudy: Amgen – Grant/Research Support.

Anthony Mangino indicated no relevant financial relationships.

Christina Leyson indicated no relevant financial relationships.

Elizabeth Harris, MD, Christian Rhudy, PharmD, MBA, Anthony A. Mangino, PhD, Christina Leyson, MD, 15, Impact of Pharmacologic Treatment for Alcohol Use Disorder on Mortality in Patients with Alcohol-Associated Liver Disease: Analysis From a United States Insurance Claims Database, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.