title: Hospitalization Costs for Patients Undergoing Orthopedic Surgery Treated With Intravenous Acetaminophen (IV-APAP) Plus Other IV Analgesics or IV Opioid Monotherapy for Postoperative Pain.
abstract: To assess the impact on hospitalization costs of multimodal analgesia (MMA), including intravenous acetaminophen (IV-APAP), versus IV opioid monotherapy for postoperative pain management in patients undergoing orthopedic surgery.
  
  
  
  Utilizing the Truven Health MarketScan®Hospital Drug Database (HDD), patients undergoing total knee arthroplasty (TKA), total hip arthroplasty (THA), or surgical repair of hip fracture between 1/1/2011 and 8/31/2014 were separated into postoperative pain management groups: MMA with IV-APAP plus other IV analgesics (IV-APAP group) or an IV opioid monotherapy group. All patients could have received oral analgesics. Baseline characteristics and total hospitalization costs were compared. Additionally, an inverse probability treatment weighting [IPTW] with propensity scores analysis further assessed hospitalization cost differences.
  
  
  
  The IV-APAP group (n = 33,954) and IV opioid monotherapy group (n = 110,300) differed significantly (P < 0.0001) across baseline characteristics, though the differences may not have been clinically meaningful. Total hospitalization costs (mean ± standard deviation) were significantly lower for the IV-APAP group than the IV opioid monotherapy group (US$12,540 ± $9564 vs. $13,242 ± $35,825; P < 0.0001). Medical costs accounted for $701 of the $702 between-group difference. Pharmacy costs were similar between groups. Results of the IPTW-adjusted analysis further supported the statistically significant cost difference.
  
  
  
  Patients undergoing orthopedic surgery who received MMA for postoperative pain management, including IV-APAP, had significantly lower total costs than patients who received IV opioid monotherapy. This difference was driven by medical costs; importantly, there was no difference in pharmacy costs. Generalizability of the results may be limited to patients admitted to hospitals similar to those included in HDD. Dosing could not be determined, so it was not possible to quantify utilization of IV-APAP or ascertain differences in opioid consumption between the 2 groups. This study did not account for healthcare utilization post-discharge.
authors.affiliation: Xcenda LLC, Palm Harbor, FL, USA.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Maiese
authors.affiliation: Health Economics and Outcomes Research Department, Mallinckrodt Pharmaceuticals, Hampton, NJ, USA. an.pham@mallinckrodt.com.
authors.forename: An T
authors.initials: AT
authors.lastname: Pham
authors.affiliation: Xcenda LLC, Palm Harbor, FL, USA.|Mapi Group, Ann Arbor, MI, USA.
authors.forename: Manasee V
authors.initials: MV
authors.lastname: Shah
authors.affiliation: Xcenda LLC, Palm Harbor, FL, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Eaddy
authors.affiliation: Xcenda LLC, Palm Harbor, FL, USA.
authors.forename: Orsolya E
authors.initials: OE
authors.lastname: Lunacsek
authors.affiliation: Health Economics and Outcomes Research Department, Mallinckrodt Pharmaceuticals, Hampton, NJ, USA.
authors.forename: George J
authors.initials: GJ
authors.lastname: Wan
mesh_terms: D000082:Acetaminophen / Q000191:economics / Q000627:therapeutic use; D061605:Administration, Intravenous; D000368:Aged; D000700:Analgesics / Q000191:economics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000191:economics; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D059408:Pain Management / Q000191:economics / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D014481:United States
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000082:Acetaminophen
keywords: Hospitalization costs; IV opioid monotherapy; Intravenous acetaminophen; Multimodal analgesia; Orthopedic surgery; Postoperative analgesia; Triple aim