Economic Analysis of Alvimopan for Prevention and Management of Postoperative Ileus

Touchette, Daniel R.; Yang, Yoojung; Tiryaki, F; Galanter, William L.

doi:10.1002/phar.1047

Cited by 25 publications

(18 citation statements)

References 38 publications

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“…Several high‐quality trials have been performed to investigate its clinical effect and meta‐analyses of these data have shown that, compared with placebo, a 12 mg dose of alvimopan accelerates time to tolerance of an oral diet, time to passage of first bowel motion and time to discharge both within and outside Enhanced Recovery After Surgery (ERAS) programs . Alvimopan has been approved by the US Food and Drug Administration and is widely used in the US for these purposes …”

Section: Pathophysiological Basis Of and Risk Factors For Poimentioning

confidence: 99%

Postoperative ileus: mechanisms and future directions for research

Vather

O’Grady

Bissett

et al. 2014

Clin Exp Pharma Physio

136

163

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Postoperative ileus (POI) is an abnormal pattern of gastrointestinal motility characterized by nausea, vomiting, abdominal distension and/or delayed passage of flatus or stool, which may occur following surgery. Postoperative ileus slows recovery, increases the risk of developing postoperative complications and confers a significant financial load on healthcare institutions. The aim of the present review is to provide a succinct overview of the clinical features and pathophysiological mechanisms of POI, with final comment on selected directions for future research.Terminology used when describing POI is inconsistent, with little differentiation made between the obligatory period of gut dysfunction seen after surgery ('normal POI') and the more clinically and pathologically significant entity of a 'prolonged POI'. Both normal and prolonged POI represent a fundamentally similar pathophysiological phenomenon. The aetiology of POI is postulated to be multifactorial, with principal mediators being inflammatory cell activation, autonomic dysfunction (both primarily and as part of the surgical stress response), agonism at gut opioid receptors, modulation of gastrointestinal hormone activity and electrolyte derangements. A final common pathway for these effectors is impaired contractility and motility and gut wall oedema. There are many potential directions for future research. In particular, there remains scope to accurately characterize the gastrointestinal dysfunction that underscores an ileus, development of an accurate risk stratification tool will facilitate early implementation of preventive measures and clinical appraisal of novel therapeutic strategies that target individual pathways in the pathogenesis of ileus warrant further investigation.

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Section: Pathophysiological Basis Of and Risk Factors For Poimentioning

confidence: 99%

Postoperative ileus: mechanisms and future directions for research

Vather

O’Grady

Bissett

et al. 2014

Clin Exp Pharma Physio

136

163

View full text Add to dashboard Cite

show abstract

“…A pooled analysis of data from the phase III trials with alvimopan showed that it significantly shortened the time to return of normal gastrointestinal function by a mean of 12–15 hours (p≤0.001) and time to discharge readiness by a mean of 14–18 hours (p<0.001) . Furthermore, a pharmacoeconomic analysis demonstrated alvimopan to be a cost‐saving intervention in patients undergoing open bowel resection when the time to discharge is reduced by 3.5 hours …”

Section: Postoperative Ileusmentioning

confidence: 99%

Clinical and Economic Burden of Opioid Use for Postsurgical Pain: Focus on Ventilatory Impairment and Ileus

Barletta

2012

Pharmacotherapy

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Opioid-related adverse drug events (ORADEs) can have a significant impact on patient recovery after surgery. This review investigates the impact of two ORADEs, respiratory depression and postoperative ileus (POI), on clinical and economic outcomes. Opioid-induced ventilatory impairment is a potentially serious ORADE that can result in apnea and even death. The incidence of ventilatory impairment is approximately 1%, even among patients receiving opioids using patient-controlled analgesia. Costs are increased in patients treated with opioids who are at high risk of ventilatory impairment due to the need for more intensive monitoring from nursing staff and the use of alarmed monitoring equipment. Opioids, together with other factors, contribute to the development of POI through a direct effect on gut motility. Postoperative ileus has been shown to significantly increase hospital length of stay and cost of care. A key determinant of ileus development, as well as length of stay and costs, is postsurgical opioid dose. Data from a retrospective analysis show that a daily hydromorphone dose of 2 mg/day markedly increases the risk of POI. In addition, although the incidence of POI is reduced in patients who undergo laparoscopic surgery or hand-assisted laparoscopic surgery compared with open surgery, the reduction of POI can potentially be negated by excessive opioid use. Therefore, multimodal, opioid-sparing strategies should be explored and used to reduce severe ORADEs and improve outcomes in the surgical setting.

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“…(13, 14, 25–27) In our study, use of alvimopan was associated with a cost savings of $636. Due to the fact that charges (and subsequently costs) are not itemized in CHARS, the mechanism of this cost savings is not known.…”

Section: Discussionmentioning

confidence: 60%

Alvimopan Use, Outcomes, and Costs: A Report from the Surgical Care and Outcomes Assessment Program Comparative Effectiveness Research Translation Network Collaborative

Ehlers

Simianu

Bastawrous

et al. 2016

Journal of the American College of Surgeons

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Background Randomized trials show that alvimopan hastens return of bowel function and reduces length of stay by one day among patients undergoing colorectal surgery. However, its effectiveness in routine clinical practice and impact on hospital costs remains uncertain. Study Design We performed a retrospective cohort study of patients undergoing elective colorectal surgery in Washington State (2009–2013) using data from a clinical registry (Surgical Care and Outcomes Assessment Program) linked to a statewide hospital discharge database (Comprehensive Hospital Abstract Reporting System). We used generalized estimating equations to evaluate the relationship between alvimopan and outcomes while adjusting for patient, operative, and management characteristics. Hospital charges were converted to costs using hospital-specific charge-to-cost ratios, and were adjusted for inflation to 2013 dollars. Results Among 14,781 patients undergoing elective colorectal surgery at 51 hospitals, 1,615 (11%) received alvimopan. Patients who received alvimopan had a LOS that was 1.8 days shorter (p<0.01) and costs that were $2,017 lower (p<0.01) compared to those who did not receive alvimopan. After adjustment, LOS was 0.9 days shorter (p<0.01), and hospital costs were $636 lower (p=0.02) among those receiving alvimopan compared to those who did not. Conclusions When used in routine clinical practice, alvimopan was associated with a shorter LOS and limited but significant hospital cost savings. Both efficacy and effectiveness data support the use of alvimopan in routine clinical practice, and its use could be measured as a marker of higher quality care.

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Economic Analysis of Alvimopan for Prevention and Management of Postoperative Ileus

Cited by 25 publications

References 38 publications

Postoperative ileus: mechanisms and future directions for research

Postoperative ileus: mechanisms and future directions for research

Clinical and Economic Burden of Opioid Use for Postsurgical Pain: Focus on Ventilatory Impairment and Ileus

Alvimopan Use, Outcomes, and Costs: A Report from the Surgical Care and Outcomes Assessment Program Comparative Effectiveness Research Translation Network Collaborative

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