Cost and efficacy examination of alvimopan for the prevention of postoperative ileus

• Published in: Journal of investigative medicine 2017-06, Vol.65 (5), p.949-952
• Main Authors: Nemeth, Zoltan H, Bogdanovski, Dorian A, Paglinco, Samantha R, Barratt-Stopper, Patricia, Rolandelli, Rolando H
• Format: Article
• Language: English
• Subjects: Aged; Body Mass Index; Female; Gastrointestinal Diseases - surgery; Health Care Costs; Humans; Ileus - economics; Ileus - prevention & control; Length of Stay; Male; Middle Aged; Piperidines - economics; Piperidines - therapeutic use; Postoperative Complications - economics; Postoperative Complications - prevention & control; Postoperative Period; Receptors, Opioid, mu - antagonists & inhibitors; Retrospective Studies; Treatment Outcome
• ISSN: 1081-5589; 1708-8267
• DOI: 10.1136/jim-2017-000449

Opioid analgesics exacerbate ileus through peripheral μ-opioid receptor action. Alvimopan, a μ-opioid receptor antagonist, has been proposed to alleviate postoperative ileus, leading to decreased time to return of gastrointestinal function and hospital discharge. As opioid-induced motility issues are only one factor affecting postoperative ileus, continued examination of the cost of the use and efficacy of the drug is needed. Data for this study were collected retrospectively from the charts of 55 patients who received an anastomosis and were given alvimopan at Morristown Medical Center between 2010 and 2013 as well as from 58 appropriately matched controls. The billing record and chart for each patient was examined, and information on total hospital charges, age, sex, body mas index, primary diagnosis, procedure type, length of stay (days), time to return of bowel function (hours), and outcomes were recorded for analysis. No difference between patients given alvimopan and controls was observed for the length of hospital stay (4.6 vs 4.8 days) or for time to return of bowel function (68.5 vs 67.3 hours). Total hospital charges were higher for treated patients (p=0.0080), averaging $48 705.15 and $41 068.80, respectively. Alvimopan was not associated with improved clinical outcome but was associated with an increase in hospital charges within this population.