Costs and healthcare utilization associated with alcohol use disorder: A cohort study

Alcohol use disorder (AUD) is the most common substance use disorder globally and is associated with increased healthcare costs and utilization. Our study aimed to compare healthcare costs and resource utilization associated with a recent diagnosis of AUD to non-AUD controls using a national database of commercially insured individuals in the United States.

This cohort study used Merative™️ MarketScan® Commercial Claims data from 2016 to 2020. We identified individuals with an AUD diagnosis in each year of the study period (2017, 2018, 2019) based on at least 1 primary/secondary AUD diagnosis in inpatient and outpatient claims using ICD-9/ICD-10 codes. Individuals were included if they were 18+ years old; had no missing values for key variables; and had at least 6 months of continuous health insurance coverage before and after the earliest date of their AUD diagnosis. We identified and measured patient-level sociodemographic and clinical characteristics. The outcomes estimated included healthcare utilization (i.e., inpatient visits and length of stay [LOS], emergency department [ED] visits, and total and AUD-indicated prescriptions) and costs (i.e., inpatient, outpatient, ED, total and AUD-indicated prescriptions). A random control group with no prior or current AUD diagnosis was identified and were matched to the AUD cohort using propensity score matching. After matching, generalized linear models were used to estimate the differences in healthcare costs and utilization between the AUD and control groups for the 6-month follow-up period.

We identified 72,410, 76,075, and 73,485 individuals with AUD in 2017, 2018, and 2019, respectively. The study cohort for each year had a mean age of 41 (SD 14) and were predominantly male (63%). In the 6-month follow-up period, individuals with AUD had significantly higher total healthcare costs compared to controls (p-value<0.0001), with an average marginal effect of $1231, $1973, and $1009, for 2017, 2018, and 2019, respectively. Individuals with AUD in each year had significantly higher healthcare utilization compared to controls for LOS, ED visits, and prescriptions (p-value<0.0001).

This study demonstrates the continuing significant disease and economic burden of individuals with AUD. Healthcare cost and resource utilization associated with AUD may be reduced through appropriate treatment.