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

Teresa L. Kauf, Robert S. Svatek, Gilad Amiel, Timothy L. Beard, Sam S. Chang, Amr Fergany, R. Jeffrey Karnes, Michael Koch, Jerome O'Hara, Cheryl T. Lee, Wade J. Sexton, Joel W. Slaton, Gary D. Steinberg, Shandra S. Wilson, Lee Techner, Carolyn Martin, Jessica Moreno, Ashish M. Kamat

Research output: Contribution to journalArticle

40 Citations (Scopus)

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. 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. 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. 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.

Original languageEnglish
Pages (from-to)1721-1727
Number of pages7
JournalJournal of Urology
Volume191
Issue number6
DOIs
StatePublished - 2014

Fingerprint

alvimopan
Narcotic Antagonists
Ileus
Cystectomy
Randomized Controlled Trials
Economics
Costs and Cost Analysis
Placebos
Hospital Costs
Health Care Costs
Phase IV Clinical Trials
Length of Stay
Patient Acceptance of Health Care
Total Parenteral Nutrition

Keywords

  • cost-benefit analysis
  • gastrointestinal tract
  • ileus
  • postoperative complications
  • urinary bladder

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

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. / Kauf, Teresa L.; Svatek, Robert S.; Amiel, Gilad; Beard, Timothy L.; Chang, Sam S.; Fergany, Amr; Karnes, R. Jeffrey; Koch, Michael; O'Hara, Jerome; Lee, Cheryl T.; Sexton, Wade J.; Slaton, Joel W.; Steinberg, Gary D.; Wilson, Shandra S.; Techner, Lee; Martin, Carolyn; Moreno, Jessica; Kamat, Ashish M.

In: Journal of Urology, Vol. 191, No. 6, 2014, p. 1721-1727.

Research output: Contribution to journalArticle

Kauf, TL, Svatek, RS, Amiel, G, Beard, TL, Chang, SS, Fergany, A, Karnes, RJ, Koch, M, O'Hara, J, Lee, CT, Sexton, WJ, Slaton, JW, Steinberg, GD, Wilson, SS, Techner, L, Martin, C, Moreno, J & Kamat, AM 2014, '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', Journal of Urology, vol. 191, no. 6, pp. 1721-1727. https://doi.org/10.1016/j.juro.2013.12.015
Kauf, Teresa L. ; Svatek, Robert S. ; Amiel, Gilad ; Beard, Timothy L. ; Chang, Sam S. ; Fergany, Amr ; Karnes, R. Jeffrey ; Koch, Michael ; O'Hara, Jerome ; Lee, Cheryl T. ; Sexton, Wade J. ; Slaton, Joel W. ; Steinberg, Gary D. ; Wilson, Shandra S. ; Techner, Lee ; Martin, Carolyn ; Moreno, Jessica ; Kamat, Ashish M. / 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. In: Journal of Urology. 2014 ; Vol. 191, No. 6. pp. 1721-1727.
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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. 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. 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. 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.",
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T1 - Alvimopan, a peripherally acting μ-opioid receptor antagonist, is associated with reduced costs after radical cystectomy

T2 - Economic analysis of a phase 4 randomized, controlled trial

AU - Kauf, Teresa L.

AU - Svatek, Robert S.

AU - Amiel, Gilad

AU - Beard, Timothy L.

AU - Chang, Sam S.

AU - Fergany, Amr

AU - Karnes, R. Jeffrey

AU - Koch, Michael

AU - O'Hara, Jerome

AU - Lee, Cheryl T.

AU - Sexton, Wade J.

AU - Slaton, Joel W.

AU - Steinberg, Gary D.

AU - Wilson, Shandra S.

AU - Techner, Lee

AU - Martin, Carolyn

AU - Moreno, Jessica

AU - Kamat, Ashish M.

PY - 2014

Y1 - 2014

N2 - 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. 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. 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. 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.

AB - 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. 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. 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. 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.

KW - cost-benefit analysis

KW - gastrointestinal tract

KW - ileus

KW - postoperative complications

KW - urinary bladder

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