To evaluate the impact of alvimopan in patient undergoing radical cystectomy (RC) for bladder cancer. We hypothesize that alvimopan can decrease cost for RC by reducing length of stay (LOS).
We identified patients who underwent elective RC for bladder cancer from 2009 to 2015 in the Premier Healthcare Database, a nationwide, all-payer hospital-based database, and compared patients who received and did not receive alvimopan in the perioperative period. Hospitals that had no record of administering alvimopan for patients undergoing RC were excluded. The primary outcomes were LOS and the direct hospital costs. The secondary outcomes were 90-day readmission for ileus and major complications.
After applying the inclusion criteria, the study cohort consisted of 1087 patients with 511 patients receiving perioperative alvimopan. Alvimopan was associated with a reduction in hospital costs by -$2,709 (95%CI: -$4,507 to -$912, p=0.003), decreased median LOS (7 vs 8 days, p<0.001), and lower likelihood of readmission for ileus (adjusted OR: 0.63, p=0.041). While alvimopan use led to higher pharmacy costs, this was outweighed by lower room and board costs due to the reduced LOS. There was no significant difference between two groups regarding major complications. These results were robust across multiple adjusted regression models.
Our data show that alvimopan is associated with a substantial cost-saving in patients undergoing radical cystectomy, and suggest that routine use of alvimopan may be a potential cost-effective strategy to reduce the overall financial burden of bladder cancer.
Urology. 2020 Apr 05 [Epub ahead of print]
Jay Tzu-Hao Huang, Alexander P Cole, Matthew Mossanen, Mark A Preston, Ye Wang, Adam S Kibel, Benjamin I Chung, William J Huang, Steven L Chang
Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Department of Urology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: ., Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA., Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA, USA., Department of Urology, Stanford University Medical Center, CA, USA., Department of Urology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.