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.
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Article info
Publication history
Published online: April 05, 2020
Footnotes
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.
Identification
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© 2020 Elsevier Inc. All rights reserved.
