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Abstract

Aim: Oliceridine, a new class of μ-opioid receptor agonist, is selective for G-protein signaling (analgesia) with limited recruitment of β-arrestin (associated with adverse outcomes) and may provide a cost-effective alternative versus conventional opioid morphine for postoperative pain. Patients & methods: Using a decision tree with a 24-h time horizon, we calculated costs for medication and management of three most common adverse events (AEs; oxygen saturation <90%, vomiting and somnolence) following postoperative oliceridine or morphine use. Results: Using oliceridine, the cost for managing AEs was US$528,424 versus $852,429 for morphine, with a net cost savings of $324,005. Conclusion: Oliceridine has a favorable overall impact on the total cost of postoperative care compared with the use of the conventional opioid morphine.

Lay abstract

Oliceridine, a new class of opioid pain medication, given in a vein, is a unique medication in that it provides pain relief comparable to morphine and may have less costly side effects. It is given in a hospital or surgery center for the treatment of postoperative pain and can save money compared with other opioid pain medicines due to fewer side effects. An economic model was developed to compare morphine to oliceridine for common side effects and pain relief following surgery. Oliceridine use resulted in a cost saving (US$324,005; 2020 US dollars) when compared with morphine.

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References

Papers of special note have been highlighted as: • of interest
1.
McDermott KW, Freeman WJ, Elixhauser A. Overview of operating room procedures during inpatient stays in U.S. hospitals, 2014: Statistical Brief #233. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality, MD, USA (2014).
2.
Small C, Laycock H. Acute postoperative pain management. Brit. J. Surg. 107(2), e70–e80 (2020).
3.
Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J. Pain Res. 10, 2287–2298 (2017).
4.
Karaca Z, McDermott KW. High-volume invasive, therapeutic ambulatory surgeries performed in hospital-owned facilities, 2016: Statistical Brief #252. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality, MD, USA (2016).
5.
Carey K, Burgess JF Jr, Young GJ. Hospital competition and financial performance: the effects of ambulatory surgery centers. Health Econ. 20(5), 571–581 (2011).
6.
Waddle JP, Evers AS, Piccirillo JF. Postanesthesia care unit length of stay: quantifying and assessing dependent factors. Anesth. Analges. 87(3), 628–633 (1998).
7.
Echeverria-Villalobos M, Stoicea N, Todeschini AB et al. Enhanced Recovery After Surgery (ERAS): a perspective review of postoperative pain management under ERAS pathways and its role on opioid crisis in the United States. Clin. J. Pain 36(3), 219–226 (2020).
8.
Brown JK, Singh K, Dumitru R, Chan E, Kim MP. The benefits of Enhanced Recovery After Surgery programs and their application in cardiothoracic surgery. Methodist DeBakey Cardiovasc. J. 14(2), 77–88 (2018).
9.
Shafi S, Collinsworth AW, Copeland LA et al. Association of opioid-related adverse drug events with clinical and cost outcomes among surgical patients in a large integrated health care delivery system. JAMA Surg. 153(8), 757–763 (2018).
• Examined the incidence of opioid-related adverse drug events (ORAEs) in patients undergoing hospital-based surgical and endoscopic procedures and reported on the association of ORAEs with clinical and cost outcomes. Reduction in ORAEs in the postsurgical setting were noted as opportunities to reduce cost and improve patient safety.
10.
Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 11(12), 1859–1871 (2010).
11.
Viscusi ER, Skobieranda F, Soergel DG, Cook E, Burt DA, Singla N. APOLLO-1: a randomized placebo and active-controlled Phase III study investigating oliceridine (TRV130), a G protein-biased ligand at the micro-opioid receptor, for management of moderate-to-severe acute pain following bunionectomy. J. Pain Res. 12, 927–943 (2019).
• Pivotal Phase III study of oliceridine in 389 patients with moderate-to-severe acute pain following orthopedic surgery – bunionectomy, treated for up to 48 h.
12.
Singla NK, Skobieranda F, Soergel DG et al. APOLLO-2: a randomized, placebo and active-controlled Phase III study investigating oliceridine (TRV130), a G protein-biased ligand at the mu-opioid receptor, for management of moderate-to-severe acute pain following abdominoplasty. Pain Pract. 19(7), 715–731 (2019).
• Pivotal Phase III study of oliceridine in 401 patients with moderate-to-severe acute pain following plastic surgery-abdominoplasty and treated for up to 24 h.
13.
Bergese SD, Brzezinski M, Hammer GB et al. ATHENA: a Phase III, open-label study of the safety and effectiveness of oliceridine (TRV130), a G-protein selective agonist at the µ-opioid receptor, in patients with moderate-to-severe acute pain requiring parenteral opioid therapy. J. Pain Res. 12, 3113–3126 (2019).
• Phase III, open-label safety study of oliceridine in a real-world population of patients (n = 768) with moderate-to-severe acute pain across a broad range of surgical procedures and nonsurgical medical conditions. Most patients received multimodal analgesic treatment concomitant with oliceridine.
14.
Husereau D, Drummond M, Petrou S et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Value Health 16(2), e1–5 (2013).
15.
Oderda GM, Senagore AJ, Morland K et al. Opioid-related respiratory and gastrointestinal adverse events in patients with acute postoperative pain: prevalence, predictors, and burden. J. Pain Palliative Care Pharmacother. 33(3–4), 82–97 (2019).
• Report of the incidence (per ICD-9 codes) of and factors influencing opioid-related respiratory depression and postoperative nausea and vomiting and associated hospital length of stay and related costs based on adult patients undergoing a surgical procedure in the Premiere Healthcare database.
16.
Barra M, Remák E, Liu DD, Xie L, Abraham L, Sadosky AB. A cost-consequence analysis of parecoxib and opioids vs opioids alone for postoperative pain: chinese perspective. ClinicoEcon. Outcomes Res. 11, 169–177 (2019).
• Analysis of the assessment of direct medical costs related to opioid-related clinically meaningful events (CMEs) based on a Phase III trial comparing parecoxib (COX-2 inhibitor) plus opioids versus opioids alone for the treatment of postoperative pain following major orthopedic, abdominal, gynecologic or noncardiac thoracic surgery.
17.
Morrison B, Kelliher L, Jones C. The economic benefits of enhanced recovery after surgery programmes. Digestive Med. Res. 2, 20 (2019).
18.
US Department of Health and Human Services – Agency for Healthcare Research and Quality (AHRQ). The Healthcare Cost and Utilization Project (HCUP), National (Nationwide) Inpatient Sample (NIS) dataset. https://hcupnet.ahrq.gov/
19.
Khanna AK, Bergese SD, Jungquist CR et al. Prediction of opioid-onduced respiratory depression on inpatient wards using continuous capnography and oximetry: an international prospective, observational trial. Anesth. Analges. 131(4), 1012–1024 (2020).
• Prospective international observational trial that developed a risk-prediction model for the PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY trial) and oximetry; study was conducted at 16 sites in USA, Europe and Asia.
20.
Rao VK, Khanna AK. Postoperative respiratory impairment is a real risk for our patients: the intensivist's perspective. Anesth. Res. Pract. 2018, 3215923 (2018).
21.
Saager L, Jiang W, Khanna AK et al. Respiratory depression on general care floors increases cost of care: results from the PRODIGY trial, Abstract #2242. Presented at: Anesthesiology 2019 Meeting. 19–23 October FL, USA, www.asaabstracts.com/strands/asaabstracts/abstract.htm?year=2019&index=17&absnum=1858
22.
Hill RP, Lubarsky DA, Phillips-Bute B et al. Cost–effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo. Anesthesiology 92(4), 958–967 (2000).
23.
Phillips C, Brookes CD, Rich J, Arbon J, Turvey TA. Postoperative nausea and vomiting following orthognathic surgery. Int. J. Oral Maxillofac. Surg. 44(6), 745–751 (2015).
24.
Schwartz J, Gan TJ. Management of postoperative nausea and vomiting in the context of an Enhanced Recovery after Surgery program. Best Pract. Res. Clin. Anaesthesiol. 34(4), 687–700 (2020).
25.
Beverly A, Kaye AD, Ljungqvist O, Urman RD. Essential elements of multimodal analgesia in Enhanced Recovery After Surgery (ERAS) guidelines. Anesthesiol. Clin. 35(2), e115–e143 (2017).