1. Learning Session #2 Philadelphia, PA March 15, 2012 May 22, 2012

2. Research Team Dennis McCarty, Ph.D. Raina Croff, Ph.D. Oregon Health & Science University Portland, OR Jay Ford, Ph.D. Kimberly Johnson, MBA University of Wisconsin NIATx Madison, WI Mady Chalk, Ph.D. Jack Kemp, MS Kelly Alanis-Hirsch, Ph.D. Treatment Research Institute Philadelphia, PA Laura Schmidt, Ph.D. University of California Berkley, CA 2

3. 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 Medication Research Partnership Project 3

4. Months 1-7Months 8-14Months 15-22Months 23-41 Oct – May 2011 - 2012 Jun – Dec 2012 Jan – Aug 2013 Sep – Apr 2013 - 2015 Change Cycle 1Change Cycle 2Change Cycle 3Follow-up Learning Session 1 (Oct 2011) Learning Session 2 (May 2012) Learning Session 3 (TBA) Learning Session 4 (TBA) Interview 1Interviews 2 & 3Interviews 4 & 5Interviews 6 &7 Periodic Coaching Calls Medication Research Partnership Participation Timeline 4

5. TX Sites NIATxTRIUCSFOHSU Aetna MRP Tx CenterLocation Bowling Green Brandywine Kennet Square, PA Eagleville HospitalEagleville, PA Horsham ClinicAmbler, PA Livengrin FoundationBensalem, PA MirmontLima, PA Mountain ManorRockville, MD Pace, Inc.Wilmington, DE Penn FoundationSellersville, PA White Deer RunAllenwood, PA Medication Research Partnership Who We Are 5

6. 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

7. 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

8. 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

9. 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

10. Medication Versus No Medication Inpatient Substance Related Days Standard Mean Difference 10

11. 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

12. Number of Days with Medication Coverage Tablet Naltrexone Disulfiram Acamprosate 12

13. Inpatient substance-abuse days* *Standardized Mean Difference Acamprosate DisulfiramTablet Naltrexone 13

14. Total Costs Tablet Naltrexone Acamprosate Disulfiram 14

15. 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

16. 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 16