Real-world impact of AUD pharmacotherapy on healthcare utilization, cost, and cost-effectiveness in the United States

BACKGROUND AND AIMS: Alcohol use disorder (AUD) imposes a substantial burden on healthcare systems in the United States. Although pharmacological treatments are effective, they remain underutilized. Real-world evidence on the economic impact and clinical effectiveness of AUD pharmacotherapy is limited. APPROACH AND RESULTS: We conducted a retrospective cohort study using Optum's de-identified Clinformatics Data Mart Database, including individuals aged ≥21 years with a new diagnosis of AUD between 2017 and 2023. Patients who initiated AUD pharmacotherapy within 1 year of diagnosis (treated group) were matched 1:1 to untreated counterparts using propensity score matching. Outcomes included alcohol-associated emergency department (ED) visits, inpatient (IP) admissions, and associated medical charges during a 1-year follow-up. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Among 218,260 patients with AUD (109,130 matched pairs), MAUD use was associated with a significantly lower likelihood of alcohol-associated hospitalization (37.6% vs. 41.4%, p