Tags

Type your tag names separated by a space and hit enter

Economic Impact of Alvimopan Considering Varying Definitions of Postoperative Ileus.
J Am Coll Surg 2015; 221(5):941-50JA

Abstract

BACKGROUND

Prolonged postoperative ileus (POI) is the predominant cause of extended hospitalization after bowel resection surgery. Alvimopan accelerates gastrointestinal recovery, potentially reducing health care costs. We examined the value of alvimopan in reducing prolonged POI and length of stay for patients undergoing abdominal surgery using different definitions of POI.

STUDY DESIGN

We developed a decision analytic model to examine costs and outcomes associated with postoperative treatment with either an accelerated care pathway (ACP) only or alvimopan+ACP. To represent an overall perspective for alvimopan, data from four phase 3 bowel resection trials and one phase 4 radical cystectomy trial were used to populate the model with 3 different definitions of POI. The period analyzed included start of surgery to 7 days post discharge. Costs were obtained from standard US costing sources and are reported in 2015 US dollars. Due to variations in published definitions of POI, alternative definitions based on adverse event reports, NG tube insertion, and time to food toleration were examined.

RESULTS

The combined clinical trial data included 1,003 ACP and 1,013 alvimopan+ACP patients. When POI was reported as an adverse event, the incidence of POI was significantly lower with alvimopan+ACP (n = 70 [7%]) vs ACP alone (n = 148 [15%]; p < 0.0001). Time to discharge order written was shorter for patients with POI who were treated with alvimopan+ACP than with ACP (202 ± 115 hours vs 266 ± 138 hours; p < 0.0001). As a result, costs were $731 lower with alvimopan+ACP ($17,835) vs ACP ($18,566). Alternative definitions of POI produced similar results.

CONCLUSIONS

The addition of alvimopan to existing treatment pathways for patients undergoing abdominal surgery can reduce overall hospital costs.

Authors+Show Affiliations

RTI Health Solutions, Research Triangle Park, NC. Electronic address: searnshaw@rti.org.Merck and Co., Inc., Kenilworth, NJ.RTI Health Solutions, Research Triangle Park, NC.Merck and Co., Inc., Kenilworth, NJ.Merck and Co., Inc., Kenilworth, NJ.RTI Health Solutions, Research Triangle Park, NC.UH/Parma Medical Center, Parma, OH.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26353904

Citation

Earnshaw, Stephanie R., et al. "Economic Impact of Alvimopan Considering Varying Definitions of Postoperative Ileus." Journal of the American College of Surgeons, vol. 221, no. 5, 2015, pp. 941-50.
Earnshaw SR, Kauf TL, McDade C, et al. Economic Impact of Alvimopan Considering Varying Definitions of Postoperative Ileus. J Am Coll Surg. 2015;221(5):941-50.
Earnshaw, S. R., Kauf, T. L., McDade, C., Potashman, M. H., Pauyo, C., Reese, E. S., & Senagore, A. (2015). Economic Impact of Alvimopan Considering Varying Definitions of Postoperative Ileus. Journal of the American College of Surgeons, 221(5), pp. 941-50. doi:10.1016/j.jamcollsurg.2015.08.004.
Earnshaw SR, et al. Economic Impact of Alvimopan Considering Varying Definitions of Postoperative Ileus. J Am Coll Surg. 2015;221(5):941-50. PubMed PMID: 26353904.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Economic Impact of Alvimopan Considering Varying Definitions of Postoperative Ileus. AU - Earnshaw,Stephanie R, AU - Kauf,Teresa L, AU - McDade,Cheryl, AU - Potashman,Michele H, AU - Pauyo,Cassandra, AU - Reese,Emily S, AU - Senagore,Anthony, Y1 - 2015/08/15/ PY - 2015/06/12/received PY - 2015/07/23/revised PY - 2015/08/03/accepted PY - 2015/9/11/entrez PY - 2015/9/12/pubmed PY - 2016/2/9/medline SP - 941 EP - 50 JF - Journal of the American College of Surgeons JO - J. Am. Coll. Surg. VL - 221 IS - 5 N2 - BACKGROUND: Prolonged postoperative ileus (POI) is the predominant cause of extended hospitalization after bowel resection surgery. Alvimopan accelerates gastrointestinal recovery, potentially reducing health care costs. We examined the value of alvimopan in reducing prolonged POI and length of stay for patients undergoing abdominal surgery using different definitions of POI. STUDY DESIGN: We developed a decision analytic model to examine costs and outcomes associated with postoperative treatment with either an accelerated care pathway (ACP) only or alvimopan+ACP. To represent an overall perspective for alvimopan, data from four phase 3 bowel resection trials and one phase 4 radical cystectomy trial were used to populate the model with 3 different definitions of POI. The period analyzed included start of surgery to 7 days post discharge. Costs were obtained from standard US costing sources and are reported in 2015 US dollars. Due to variations in published definitions of POI, alternative definitions based on adverse event reports, NG tube insertion, and time to food toleration were examined. RESULTS: The combined clinical trial data included 1,003 ACP and 1,013 alvimopan+ACP patients. When POI was reported as an adverse event, the incidence of POI was significantly lower with alvimopan+ACP (n = 70 [7%]) vs ACP alone (n = 148 [15%]; p < 0.0001). Time to discharge order written was shorter for patients with POI who were treated with alvimopan+ACP than with ACP (202 ± 115 hours vs 266 ± 138 hours; p < 0.0001). As a result, costs were $731 lower with alvimopan+ACP ($17,835) vs ACP ($18,566). Alternative definitions of POI produced similar results. CONCLUSIONS: The addition of alvimopan to existing treatment pathways for patients undergoing abdominal surgery can reduce overall hospital costs. SN - 1879-1190 UR - https://www.unboundmedicine.com/medline/citation/26353904/Economic_Impact_of_Alvimopan_Considering_Varying_Definitions_of_Postoperative_Ileus_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072-7515(15)00977-1 DB - PRIME DP - Unbound Medicine ER -