Cost and Efficacy Examination of Alvimopan for the Prevention of Postoperative Ileus

Abstract

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.

Peripherally Acting μ-Opioid Receptor Antagonists in the Management of Postoperative Ileus: a Clinical Review

“…In a recent small retrospective analysis of alvimopan (n = 55) and matched controls (n = 58), the authors found no significant difference in length of hospital stay (4.6 vs 4.8 days; P = 0.72) or mean time to return to bowel function (68.5 vs 67.3 h; P = 0.83). 38 This study demonstrated that patients treated with alvimopan incurred significantly greater charges for medical and surgical supplies, pathology and cytology services, operating room charges, and therapy charges (P < 0.05). 38 However, these increases in costs were largely associated with surgical time and a shift in hospitalwide accelerated recovery efforts; they may also be due to differences in surgical complexity between groups.…”

“…38 This study demonstrated that patients treated with alvimopan incurred significantly greater charges for medical and surgical supplies, pathology and cytology services, operating room charges, and therapy charges (P < 0.05). 38 However, these increases in costs were largely associated with surgical time and a shift in hospitalwide accelerated recovery efforts; they may also be due to differences in surgical complexity between groups. 38 Nevertheless, this suggests that patient selection is important in deciding who should receive ERAS interventions, including PAMORAs, such as alvimopan.…”

“…38 However, these increases in costs were largely associated with surgical time and a shift in hospitalwide accelerated recovery efforts; they may also be due to differences in surgical complexity between groups. 38 Nevertheless, this suggests that patient selection is important in deciding who should receive ERAS interventions, including PAMORAs, such as alvimopan.…”

Effect of Yikou-Sizi powder hot compress on gastrointestinal functional recovery in patients after abdominal surgery

“…[ 31 ] Alvimopan opioid receptor antagonists have recently been developed in the United States for POI, and have been introduced in China, and mainly used in cases of colon failure and to improve gastrointestinal transit function after surgery and decrease postoperative inflammation caused by an excess of nitric oxide that is released after muscular layer infiltration. [ 2 , 32 , 33 ] Therefore, when the local inflammatory response causes more intense symptoms of POI, alvimopan may no longer be an effective means to promote the recovery of POI. [ 33 , 34 ]…”

“…[ 2 , 32 , 33 ] Therefore, when the local inflammatory response causes more intense symptoms of POI, alvimopan may no longer be an effective means to promote the recovery of POI. [ 33 , 34 ]…”