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Alvimopan for prevention of postoperative paralytic ileus in radical cystectomy patients: a cost-effectiveness analysis.

Abstract

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: No cost-effectiveness studies exist in patients after radical cystectomy for the routine use of alvimopan for the prevention of postoperative ileus. The present study provides a reasonable estimate of the cost-effectiveness of alvimopan for the prevention of postoperative ileus in the patient after radical cystectomy.

OBJECTIVE

To determine if the cost of administering alvimopan, to help restore bowel function after abdominal surgery, to all patients undergoing radical cystectomy (RC) is cost prohibitive.

PATIENTS AND METHODS

A cost-effective analysis was conducted from a healthcare payer perspective using a decision-tree model that incorporated direct healthcare costs and probabilities associated with the possible events and outcomes. Sensitivity analyses were conducted on the influence of the cost and effectiveness of the drug, the probability of POI in RC patients, and the extended length of stay (LOS) as a result of POI. Precision in estimates was determined using probabilistic sensitivity analyses with 5000 Monte-Carlo simulations.

RESULTS

Under the base case assumption, the additional cost of a patient's LOS related to POI was $10 246 per person. Under the assumption that 15.6% of patients will have POI, the mean cost associated with POI in a cohort of patients not treated with alvimopan was $1597 (90% confidence interval [CI] $1335-1875) per patient. Conversely, the routine use of alvimopan for all patients undergoing RC was associated with a mean POI-associated cost of $1495(90% CI $1312-1696) per person, which represents the cost of alvimopan ($700 per hospitalisation) and a 50% reduction in the rate of POI. Sensitivity analyses revealed that there is a cost savings with the routine use of alvimopan under the following conditions: the POI results in extending LOS by ≥3.5 days, POI occurs in ≥14% of patients undergoing RC, or the drug results in a relative risk reduction of ≥44%.

CONCLUSIONS

Routine use of perioperative alvimopan may not be cost prohibitive because of its influence on POI rate and associated costs. The cost-effectiveness of alvimopan is influenced by the POI incidence and the degree to which the drug can decrease the LOS.

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  • Authors+Show Affiliations

    ,

    University of Texas Health Science Center, San Antonio, TX 78229, USA.

    , , ,

    Source

    BJU international 111:7 2013 Jun pg 1054-60

    MeSH

    Cost-Benefit Analysis
    Cystectomy
    Female
    Gastrointestinal Agents
    Gastrointestinal Motility
    Humans
    Intestinal Pseudo-Obstruction
    Length of Stay
    Male
    Piperidines
    Postoperative Period

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    23171223

    Citation

    Hilton, William M., et al. "Alvimopan for Prevention of Postoperative Paralytic Ileus in Radical Cystectomy Patients: a Cost-effectiveness Analysis." BJU International, vol. 111, no. 7, 2013, pp. 1054-60.
    Hilton WM, Lotan Y, Parekh DJ, et al. Alvimopan for prevention of postoperative paralytic ileus in radical cystectomy patients: a cost-effectiveness analysis. BJU Int. 2013;111(7):1054-60.
    Hilton, W. M., Lotan, Y., Parekh, D. J., Basler, J. W., & Svatek, R. S. (2013). Alvimopan for prevention of postoperative paralytic ileus in radical cystectomy patients: a cost-effectiveness analysis. BJU International, 111(7), pp. 1054-60. doi:10.1111/j.1464-410X.2012.11499.x.
    Hilton WM, et al. Alvimopan for Prevention of Postoperative Paralytic Ileus in Radical Cystectomy Patients: a Cost-effectiveness Analysis. BJU Int. 2013;111(7):1054-60. PubMed PMID: 23171223.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Alvimopan for prevention of postoperative paralytic ileus in radical cystectomy patients: a cost-effectiveness analysis. AU - Hilton,William M, AU - Lotan,Yair, AU - Parekh,Dipen J, AU - Basler,Joseph W, AU - Svatek,Robert S, Y1 - 2012/11/21/ PY - 2012/11/23/entrez PY - 2012/11/23/pubmed PY - 2013/7/31/medline SP - 1054 EP - 60 JF - BJU international JO - BJU Int. VL - 111 IS - 7 N2 - UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: No cost-effectiveness studies exist in patients after radical cystectomy for the routine use of alvimopan for the prevention of postoperative ileus. The present study provides a reasonable estimate of the cost-effectiveness of alvimopan for the prevention of postoperative ileus in the patient after radical cystectomy. OBJECTIVE: To determine if the cost of administering alvimopan, to help restore bowel function after abdominal surgery, to all patients undergoing radical cystectomy (RC) is cost prohibitive. PATIENTS AND METHODS: A cost-effective analysis was conducted from a healthcare payer perspective using a decision-tree model that incorporated direct healthcare costs and probabilities associated with the possible events and outcomes. Sensitivity analyses were conducted on the influence of the cost and effectiveness of the drug, the probability of POI in RC patients, and the extended length of stay (LOS) as a result of POI. Precision in estimates was determined using probabilistic sensitivity analyses with 5000 Monte-Carlo simulations. RESULTS: Under the base case assumption, the additional cost of a patient's LOS related to POI was $10 246 per person. Under the assumption that 15.6% of patients will have POI, the mean cost associated with POI in a cohort of patients not treated with alvimopan was $1597 (90% confidence interval [CI] $1335-1875) per patient. Conversely, the routine use of alvimopan for all patients undergoing RC was associated with a mean POI-associated cost of $1495(90% CI $1312-1696) per person, which represents the cost of alvimopan ($700 per hospitalisation) and a 50% reduction in the rate of POI. Sensitivity analyses revealed that there is a cost savings with the routine use of alvimopan under the following conditions: the POI results in extending LOS by ≥3.5 days, POI occurs in ≥14% of patients undergoing RC, or the drug results in a relative risk reduction of ≥44%. CONCLUSIONS: Routine use of perioperative alvimopan may not be cost prohibitive because of its influence on POI rate and associated costs. The cost-effectiveness of alvimopan is influenced by the POI incidence and the degree to which the drug can decrease the LOS. SN - 1464-410X UR - https://www.unboundmedicine.com/medline/citation/23171223/Alvimopan_for_prevention_of_postoperative_paralytic_ileus_in_radical_cystectomy_patients:_a_cost_effectiveness_analysis_ L2 - https://doi.org/10.1111/j.1464-410X.2012.11499.x DB - PRIME DP - Unbound Medicine ER -