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Alvimopan, a peripherally acting μ-opioid receptor antagonist, is associated with reduced costs after radical cystectomy: economic analysis of a phase 4 randomized, controlled trial.
- Source :
-
The Journal of urology [J Urol] 2014 Jun; Vol. 191 (6), pp. 1721-7. Date of Electronic Publication: 2013 Dec 14. - Publication Year :
- 2014
-
Abstract
- Purpose: We evaluated the effect of alvimopan treatment vs placebo on health care utilization and costs related to gastrointestinal recovery in patients treated with radical cystectomy in a randomized, phase 4 clinical trial.<br />Materials and Methods: Resource utilization data were prospectively collected and evaluated by cost consequence analysis. Hospital costs were estimated from 2012 Medicare reimbursement rates and medication wholesale acquisition costs. Differences in base case mean costs between the study cohorts for total postoperative ileus related costs (hospital days, study drug, nasogastric tubes, postoperative ileus related concomitant medication and postoperative ileus related readmissions) and total combined costs (postoperative ileus related, laboratory, electrocardiograms, nonpostoperative ileus related concomitant medication and nonpostoperative ileus related readmission) were evaluated by probabilistic sensitivity analysis using a bootstrap approach.<br />Results: Mean hospital stay was 2.63 days shorter for alvimopan than placebo (mean±SD 8.44±3.05 vs 11.07±8.23 days, p=0.005). Use of medications or interventions likely intended to diagnose or manage postoperative ileus was lower for alvimopan than for placebo, eg total parenteral nutrition 10% vs 25% (p=0.001). Postoperative ileus related health care costs were $2,340 lower for alvimopan and mean total combined costs were decreased by $2,640 per patient for alvimopan vs placebo. Analysis using a 10,000-iteration bootstrap approach showed that the mean difference in postoperative ileus related costs (p=0.04) but not total combined costs (p=0.068) was significantly lower for alvimopan than for placebo.<br />Conclusions: In patients treated with radical cystectomy alvimopan decreased hospitalization cost by reducing the health care services associated with postoperative ileus and decreasing the hospital stay.<br /> (Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Administration, Oral
Costs and Cost Analysis
Cystectomy methods
Double-Blind Method
Follow-Up Studies
Gastrointestinal Agents administration & dosage
Gastrointestinal Agents therapeutic use
Humans
Ileus economics
Ileus epidemiology
Incidence
Piperidines administration & dosage
Postoperative Complications economics
Postoperative Complications epidemiology
Prospective Studies
Receptors, Opioid, mu antagonists & inhibitors
United States epidemiology
Cystectomy economics
Hospital Costs trends
Ileus prevention & control
Patient Acceptance of Health Care statistics & numerical data
Piperidines therapeutic use
Postoperative Complications prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1527-3792
- Volume :
- 191
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Journal of urology
- Publication Type :
- Academic Journal
- Accession number :
- 24342144
- Full Text :
- https://doi.org/10.1016/j.juro.2013.12.015