Economic analysis of alvimopan for prevention and management of postoperative ileus.
Economic analysis of alvimopan for prevention and management of postoperative ileus.
复制标题
阿维莫泮预防和治疗术后肠梗阻的经济分析。
DOI：
10.1002/phar.1047
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发表时间：
2012
期刊：
影响因子：
4.1
通讯作者：
Galanter,WilliamL
中科院分区：
文献类型：
--
作者：
Touchette,DanielR;Yang,Yoojung;Tiryaki,Funda;Galanter,WilliamL
研究目的确定与标准护理相比，阿维莫潘用于预防剖腹小肠或大肠切除术患者术后肠梗阻是否与降低总成本有关。使用正式的决策模型设计药物经济学分析。数据来源四项III期临床试验、两项汇集分析和一项荟萃分析。患者群一组接受开腹肠道切除和一期吻合术的患者，接受标准化、加速的术后护理(通常护理)或常规护理加阿维莫潘。测量和主要结果从已发表研究的汇总分析中获得的临床结果是出院时间、术后鼻胃管插入、术后7天内与肠梗阻相关的再入院以及恶心和呕吐的发生。成本投入包括药物、护理劳动力、再入院和住院治疗。通过确定使用阿维莫班的净费用和随后减少的住院时间来评估费用。进行了敏感性分析和情景分析。到2021年，阿维莫班的使用减少了住院成本。通过蒙特卡罗模拟确定的总体护理费用的平均差异为1168(95%确定区间favoringtheuseofalvimopan.Inthesensitivityanalysis，associationofalvimopanwithlowercostswasrobusttoseveralchangesinkeyparametersincludingcostandnumberofdosesofalvimopan，437至5879)、出院时间、再住院率和住院费用。在分析中，假设出院时间没有差异，则−的平均成本为226。在使用没有强制阿片类药物使用的研究数据的情景分析中，阿维莫潘导致了65/patient.ConclusionAlvimopanwascostsavingforpreventionofpostoperativeileusinpatientsundergoingbowelresectionbylaparotomy，althoughthesepotentialcostsavingswerehighlydependentonadifferenceintimetodischargeorderwritten.Thisfindingisnotapplicabletotheless‐invasivelaparoscopicsurgicalapproachforwhichqualitydataonalvimopanusearelacking.Limitationsofthisanalysisincludeduseoftimetodischargeorderwrittenasaproxyforlengthofstayanddifficultyinterpretingstudyresultsduetoinconsistentreportingandconductoftheclinicaltrialsevaluatingalvimopan.Moreresearchisneededtodeterminethecost‐effectivenessofalvimopan.的成本节约
Study Objective To determine whether alvimopan for prevention of postoperative ileus in patients undergoing small‐or large‐bowel resection by laparotomy is associated with lower total costs compared with standard care. Design Pharmacoeconomic analysis using a formal decision model. Data Source Four phase III clinical trials, two pooled analyses, and one meta‐analysis. Patient Population A cohort of patients who underwent bowel resection with primary anastomosis by laparotomy and received either standardized, accelerated postoperative care (usual care) or usual care plus alvimopan. Measurements and Main Results Clinical outcomes, obtained from pooled analyses of published studies, were time to discharge order written, postoperative nasogastric tube insertion, postoperative ileus‐related readmission within 7 days, and occurrence of nausea and vomiting. Cost inputs included drugs, nursing labor, readmissions, and hospitalizations. Costs were assessed by determining the net cost of alvimopan use and subsequent reduction in length of stay. Sensitivity and scenario analyses were conducted. Costs for alvimopan were 570basedonanaverageof9.5doses.Giventhe18.4‐hourmeanreductionintimetodischargeorderwritten,useofalvimopanreducedhospitalizationcostsby 2021. Mean difference in overall cost of care, as determined by Monte Carlo simulation, was 1168(95%certaintyinterval− 437 to 5879),favoringtheuseofalvimopan.Inthesensitivityanalysis,associationofalvimopanwithlowercostswasrobusttoseveralchangesinkeyparametersincludingcostandnumberofdosesofalvimopan,timetodischargeorderwritten,readmissionrates,andhospitalizationcost.Inthescenarioanalyses,alvimopanuseyieldedanetcostof 226 when no difference in time to discharge order written was assumed. In the scenario analysis using data from a study that did not enforce opioid use, alvimopan resulted in a cost saving of 65/patient.ConclusionAlvimopanwascostsavingforpreventionofpostoperativeileusinpatientsundergoingbowelresectionbylaparotomy,althoughthesepotentialcostsavingswerehighlydependentonadifferenceintimetodischargeorderwritten.Thisfindingisnotapplicabletotheless‐invasivelaparoscopicsurgicalapproachforwhichqualitydataonalvimopanusearelacking.Limitationsofthisanalysisincludeduseoftimetodischargeorderwrittenasaproxyforlengthofstayanddifficultyinterpretingstudyresultsduetoinconsistentreportingandconductoftheclinicaltrialsevaluatingalvimopan.Moreresearchisneededtodeterminethecost‐effectivenessofalvimopan.