This study was supported by the Agency for Healthcare Research and Quality (grant U18HS016973), which funded the University of Illinois at Chicago Center for Education and Research in Therapeutics program. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
Original Research Articles
Economic Analysis of Alvimopan for Prevention and Management of Postoperative Ileus
Article first published online: 24 JAN 2012
© 2012 Pharmacotherapy Publications, Inc.
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Volume 32, Issue 2, pages 120–128, February 2012
How to Cite
Touchette, D. R., Yang, Y., Tiryaki, F. and Galanter, W. L. (2012), Economic Analysis of Alvimopan for Prevention and Management of Postoperative Ileus. Pharmacotherapy, 32: 120–128. doi: 10.1002/PHAR.1047
- Issue published online: 30 JAN 2012
- Article first published online: 24 JAN 2012
- Manuscript Accepted: 12 SEP 2011
- Manuscript Revised: 15 AUG 2011
- Manuscript Received: 14 JUL 2011
- Agency for Healthcare Research and Quality. Grant Number: U18HS016973
- surgery outcomes;
- evidence-based medicine;
To determine whether alvimopan for prevention of postoperative ileus in patients undergoing small- or large-bowel resection by laparotomy is associated with lower total costs compared with standard care.
Pharmacoeconomic analysis using a formal decision model.
Four phase III clinical trials, two pooled analyses, and one meta-analysis.
A cohort of patients who underwent bowel resection with primary anastomosis by laparotomy and received either standardized, accelerated postoperative care (usual care) or usual care plus alvimopan.
Measurements and Main Results
Clinical outcomes, obtained from pooled analyses of published studies, were time to discharge order written, postoperative nasogastric tube insertion, postoperative ileus-related readmission within 7 days, and occurrence of nausea and vomiting. Cost inputs included drugs, nursing labor, readmissions, and hospitalizations. Costs were assessed by determining the net cost of alvimopan use and subsequent reduction in length of stay. Sensitivity and scenario analyses were conducted. Costs for alvimopan were $570 based on an average of 9.5 doses. Given the 18.4-hour mean reduction in time to discharge order written, use of alvimopan reduced hospitalization costs by $2021. Mean difference in overall cost of care, as determined by Monte Carlo simulation, was $1168 (95% certainty interval −$437 to $5879), favoring the use of alvimopan. In the sensitivity analysis, association of alvimopan with lower costs was robust to several changes in key parameters including cost and number of doses of alvimopan, time to discharge order written, readmission rates, and hospitalization cost. In the scenario analyses, alvimopan use yielded a net cost of $226 when no difference in time to discharge order written was assumed. In the scenario analysis using data from a study that did not enforce opioid use, alvimopan resulted in a cost saving of $65/patient.
Alvimopan was cost saving for prevention of postoperative ileus in patients undergoing bowel resection by laparotomy, although these potential cost savings were highly dependent on a difference in time to discharge order written. This finding is not applicable to the less-invasive laparoscopic surgical approach for which quality data on alvimopan use are lacking. Limitations of this analysis included use of time to discharge order written as a proxy for length of stay and difficulty interpreting study results due to inconsistent reporting and conduct of the clinical trials evaluating alvimopan. More research is needed to determine the cost-effectiveness of alvimopan.