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Comprehensive retrospective insurance claims analyses are few but tend to be nationally distributed and large. The emerging pattern is that, while treatment in general is cost effective, specific therapeutics can yield different health economic outcomes. Cost\/utilization data consistently show greater savings with pharmacotherapies (despite their costs) versus psychosocial treatment alone. All FDA\u2010approved addiction pharmacotherapies (oral naltrexone, extended\u2010release naltrexone, acamprosate, disulfiram, buprenorphine, buprenorphine\/naloxone, and methadone) are intended for use in conjunction with psychosocial management, not as stand\u2010alone therapeutics; hence, pharmacotherapy costs must offer benefits in addition to abstinence alone or psychological therapy. Patient persistence is problematic, and (despite its cost) extended\u2010release pharmacotherapy may be associated with lower or no greater total healthcare cost, mostly due to reduced hospitalization. The reviewed studies use rigorous case\u2010mix adjustment to balance treatment cohorts but lack the randomization that clinical trials use to protect against confounding. 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