Alvimopan for prevention of postoperative paralytic ileus in radical cystectomy patients: a cost‐effectiveness analysis. (21st November 2012)

• Record Type: Journal Article
• Authors: Hilton, William M.; Lotan, Yair; Parekh, Dipen J.; Basler, Joseph W.; Svatek, Robert S.
• Is Part Of: BJU international. Volume 111:Number 7(2013:Apr.)
• Page Start: 1054
• Page End: 1060
• Publication Date: 2012-11-21
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/j.1464-410X.2012.11499.x
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju11499-sec-0001" sec-type="section"> <title>What's known on the subject? and What does the study add?</title> <p> <list id="bju11499-list-1001" list-type="bullet"> <list-item> <p>No cost‐effectiveness studies exist in patients after radical cystectomy for the routine use of alvimopan for the prevention of postoperative ileus.</p> </list-item> <list-item> <p>The present study provides a reasonable estimate of the cost‐effectiveness of alvimopan for the prevention of postoperative ileus in the patient after radical cystectomy.</p> </list-item> </list> </p> </sec> <sec id="bju11499-sec-0002" sec-type="section"> <title>Objective</title> <p> <list id="bju11499-list-0001" list-type="bullet"> <list-item> <p>To determine if the cost of administering alvimopan, to help restore bowel function after abdominal surgery, to all patients undergoing radical cystectomy (RC) is cost prohibitive.</p> </list-item> </list> </p> </sec> <sec id="bju11499-sec-0003" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju11499-list-0002" list-type="bullet"> <list-item> <p>A cost‐effective analysis was conducted from a healthcare payer perspective using a decision‐tree model that incorporated direct healthcare costs and probabilities associated with the possible events and outcomes.</p> </list-item> <list-item> <p>Sensitivity analyses were conducted on the influence of the cost and effectiveness of the drug, the probability of POI in RC patients, and the extended length of stay (LOS) as a result of POI.</p> </list-item> <list-item> <p>Precision in estimates was determined using probabilistic sensitivity analyses with 5000 Monte‐Carlo simulations.</p> </list-item> </list> </p> </sec> <sec id="bju11499-sec-0004" sec-type="section"> <title>Results</title> <p> <list id="bju11499-list-0003" list-type="bullet"> <list-item> <p>Under the base case assumption, the additional cost of a patient's LOS related to POI was $10 246 per person. Under the assumption that 15.6% of patients will have POI, the mean cost associated with POI in a cohort of patients not treated with alvimopan was $1597 (90% confidence interval [CI] $1335–1875) per patient.</p> </list-item> <list-item> <p>Conversely, the routine use of alvimopan for all patients undergoing RC was associated with a mean POI‐associated cost of $1495(90% CI $1312–1696) per person, which represents the cost of alvimopan ($700 per hospitalisation) and a 50% reduction in the rate of POI.</p> </list-item> <list-item> <p>Sensitivity analyses revealed that there is a cost savings with the routine use of alvimopan under the following conditions: the POI results in extending LOS by ≥3.5 days, POI occurs in ≥14% of patients undergoing RC, or the drug results in a relative risk reduction of ≥44%.</p> </list-item> </list> </p> </sec> <sec id="bju11499-sec-0005" sec-type="section"> <title>Conclusions</title> <p> <list id="bju11499-list-0004" list-type="bullet"> <list-item> <p>Routine use of perioperative alvimopan may not be cost prohibitive because of its influence on POI rate and associated costs.</p> </list-item> <list-item> <p>The cost‐effectiveness of alvimopan is influenced by the POI incidence and the degree to which the drug can decrease the LOS.</p> </list-item> </list> </p> </sec> </abstract>