Alvimopan Is Associated With a Reduction in Length of Stay and Hospital Costs for Patients Undergoing Radical Cystectomy - 05/01/21

Doi : 10.1016/j.urology.2020.01.049

Jay Tzu-Hao Huang ^1,^2,^⁎ , Alexander P. Cole ¹, Matthew Mossanen ^1,³, Mark A. Preston ^1,³, Ye Wang ¹, Adam S. Kibel ^1,³, Benjamin I. Chung ⁴, William J. Huang ², Steven L. Chang ^1,³
¹ Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
² Department of Urology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
³ Dana-Farber/Brigham and Women's Hospital Cancer Center, Harvard Medical School, Boston, MA
⁴ Department of Urology, Stanford University Medical Center, Stanford, CA

^⁎Address correspondence to: Jay Tzu-Hao Huang, M.D., Division of Urological Surgery, Brigham and Women's Hospital, 45 Francis Street, ASB II–3; Boston, MA 02115Division of Urological SurgeryBrigham and Women's Hospital45 Francis Street, ASB II–3BostonMA02115

Résumé

Objective

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).

Methods

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.

Results

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 −$2709 (95% confidence interval: −$4507 to −$912, P = .003), decreased median LOS (7 vs 8 days, P < .001), and lower likelihood of readmission for ileus (adjusted odds ratio: 0.63, P = .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 2 groups regarding major complications. These results were robust across multiple adjusted regression models.

Conclusion

Our data show that alvimopan is associated with a substantial cost-saving in patients undergoing RC, and suggest that routine use of alvimopan may be a potential cost-effective strategy to reduce the overall financial burden of bladder cancer.

Le texte complet de cet article est disponible en PDF.

Plan

Financial Support: Jay Tzu-Hao Huang was sponsored by Taipei Veterans General Hospital-National Yang-Ming University Excellent Physician Scientists Cultivation Program, No. 107-V-A-007.