Poston Sara, Broder Michael S, Gibbons Melinda Maggard, Maclaren Robert, Chang Eunice, Vandepol Christine J, Cook Suzanne F, Techner Lee
P T. 2011 Apr;36(4):209-20.
Delayed gastrointestinal (GI) recovery after bowel resection is associated with longer hospital stays and increased health care costs. Alvimopan (Entereg), a peripherally acting mu-opioid receptor antagonist, accelerates GI recovery after bowel-resection surgery. We undertook a study to evaluate the economic impact of alvimopan in clinical practice.
We conducted a retrospective matched cohort study using data from a large national hospital database and identified adults who had undergone small-bowel or large-bowel resection with primary anastomosis. The patients were discharged between January 1, 2009, and June 30, 2009. The surgery was performed at a hospital where alvimopan was used at least once during the study period. We matched each alvimopan patient ("user") with two controls ("non-users"). The primary outcome of total hospital costs (including the cost of alvimopan) and secondary outcomes of cost components and length of stay were compared between groups.
The final study cohort included 480 alvimopan patients and 960 matched controls. The mean total hospital cost was $12,865 for alvimopan patients, compared with $13,905 for controls, for a difference of $1,040 (P = 0.033). There was a non-significant trend toward lower ileus-related costs between groups ($83 for alvimopan vs. $114 for controls, P = 0.086). Pharmacy and diagnostic radiology costs did not differ significantly. The mean length of stay was 5.6 days for alvimopan patients and 6.5 days for controls (P < 0.001).
Patients receiving alvimopan capsules had significantly lower total hospital costs compared with controls. Along with other initiatives to improve quality and reduce costs of surgical care, alvimopan might be a good choice for use in the perioperative management of patients who undergo segmental bowel resection with primary anastomosis.
肠切除术后胃肠道（GI）恢复延迟与住院时间延长及医疗费用增加相关。外周作用的μ-阿片受体拮抗剂阿维莫潘（Entereg）可加速肠切除术后的胃肠道恢复。我们开展了一项研究以评估阿维莫潘在临床实践中的经济影响。
我们使用来自一个大型国家医院数据库的数据进行了一项回顾性匹配队列研究，确定了接受小肠或大肠切除并进行一期吻合的成年人。患者于2009年1月1日至2009年6月30日期间出院。手术在研究期间至少使用过一次阿维莫潘的医院进行。我们将每位阿维莫潘患者（“使用者”）与两名对照（“非使用者”）进行匹配。比较两组之间的总住院费用（包括阿维莫潘的费用）主要结局以及费用构成和住院时间的次要结局。
最终研究队列包括480名阿维莫潘患者和960名匹配对照。阿维莫潘患者的平均总住院费用为12,865美元，而对照为13,905美元，差值为1,040美元（P = 0.033）。两组之间肠梗阻相关费用有降低的非显著趋势（阿维莫潘组为83美元，对照组为114美元，P = 0.086）。药房和诊断放射学费用无显著差异。阿维莫潘患者的平均住院时间为5.6天，对照为6.5天（P < 0.001）。
与对照组相比，接受阿维莫潘胶囊治疗的患者总住院费用显著降低。除了其他改善手术护理质量和降低成本的举措外，阿维莫潘可能是用于接受一期吻合节段性肠切除患者围手术期管理的一个不错选择。
