Economic Impact of Alvimopan Considering Varying Definitions of Postoperative Ileus.
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.


METHODS
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.
RTI Health Solutions, Research Triangle Park, NC. Electronic address: searnshaw@rti.org.
Stephanie R
SR
Earnshaw
Merck and Co., Inc., Kenilworth, NJ.
Teresa L
TL
Kauf
RTI Health Solutions, Research Triangle Park, NC.
Cheryl
C
McDade
Merck and Co., Inc., Kenilworth, NJ.
Michele H
MH
Potashman
Merck and Co., Inc., Kenilworth, NJ.
Cassandra
C
Pauyo
RTI Health Solutions, Research Triangle Park, NC.
Emily S
ES
Reese
UH/Parma Medical Center, Parma, OH.
Anthony
A
Senagore
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000191:economics; D003663:Decision Trees; D013505:Digestive System Surgical Procedures / Q000191:economics; D005260:Female; D005765:Gastrointestinal Agents / Q000191:economics / Q000627:therapeutic use*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D045823:Ileus / Q000188:drug therapy* / Q000191:economics / Q000209:etiology / Q000628:therapy; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010880:Piperidines / Q000191:economics / Q000627:therapeutic use*; D011182:Postoperative Care / Q000191:economics*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D014481:United States; D055815:Young Adult
D005765:Gastrointestinal Agents; D010880:Piperidines; C419502:alvimopan