Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; Department of Urology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Division of Urology, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
Urology. 2020 Jun;140:115-121. doi: 10.1016/j.urology.2020.01.049. Epub 2020 Apr 5.
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 -$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.
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.
评估 alvimopan 对膀胱癌根治性膀胱切除术（RC）患者的影响。我们假设 alvimopan 可以通过缩短住院时间（LOS）来降低 RC 的成本。
我们从 Premier Healthcare Database 中确定了 2009 年至 2015 年间接受膀胱癌择期 RC 的患者，并比较了围手术期接受和未接受 alvimopan 的患者。排除了没有记录 RC 患者接受 alvimopan 的医院。主要结局是 LOS 和直接医院费用。次要结局是术后 90 天因肠梗阻和主要并发症再入院。
在应用纳入标准后，研究队列包括 1087 例患者，其中 511 例患者接受围手术期 alvimopan 治疗。alvimopan 与医院成本降低 -$2709（95%置信区间：-$4507 至 -$912，P=0.003）、中位 LOS 缩短（7 天与 8 天，P<0.001）和肠梗阻再入院的可能性降低（调整后的优势比：0.63，P=0.041）相关。虽然 alvimopan 的使用导致了更高的药房费用，但由于 LOS 缩短，病房和董事会的成本降低，这一成本被抵消了。两组之间在主要并发症方面没有显著差异。这些结果在多个调整后的回归模型中是稳健的。
我们的数据表明，alvimopan 与 RC 患者的大量成本节约相关，并表明常规使用 alvimopan 可能是一种降低膀胱癌整体经济负担的潜在有效策略。
