Economic Analysis of Alvimopan for Prevention and Management of Postoperative Ileus

Objective: To determine whether alvimopan for prevention of post-operative ileus (POI) among patients undergoing small- or large-bowel resection via laparotomy is associated with lower total costs compared to standard post-operative care. Methods: We constructed a formal decision model from the healthcare system perspective. Clinical outcomes (time to discharge order written [DCO], post-operative nasogastric tube insertion, POI-related readmission within 7 days, nausea and vomiting) were obtained from meta-analyses of published studies. Cost inputs included drugs, nursing labor, readmission, and hospitalization. Costs were assessed by determining the net cost of alvimopan use and subsequent reduction in length of stay (LOS). Sensitivity analyses and a scenario analysis were conducted. Results: The costs for alvimopan were $570 based on an average of 9.5 doses. Given the 18.4-hour mean reduction in DCO, the use of alvimopan reduced hospitalization costs by $2,021. The mean difference in overall cost of care was $1,168 (95% certainty interval: -$-437 to $5,879), favoring the use of alvimopan. In sensitivity analyses, the association of alvimopan with lower costs was robust to several changes in key parameters including the cost and number of doses of alvimopan, DCO, readmission rates, and hospitalization cost. In scenario analyses, alvimopan use yielded a cost saving of $897 when no difference in readmission rates was assumed and a net cost of $278 when no difference in Touchette DR et al. Economic Analysis of Alvimopan for POI Page 4 of 27 DCO 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 per patient. Conclusion: For the base case, alvimopan was cost-saving for prevention of POI among patients undergoing bowel resection via laparotomy, although these potential cost-savings were highly dependent on a difference in DCO. 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 the use of DCO as a proxy for LOS and difficulty interpreting study results due to inconsistent reporting and conduct of the clinical trials evaluating alvimopan.