OBJECTIVES :

Use of conventional opioids for postoperative pain are associated with adverse events (ORAEs) that can affect health outcomes, compromising analgesia. Oliceridine, a new class of µ-opioid receptor IV agonist , is selective for G-protein signaling (achieving analgesia) with limited recruitment of β-arrestin (associated with ORAEs). Here we estimate the budget impact of oliceridine vs morphine for postoperative pain.

METHODS :

We compared costs & outcomes of patients managed with demand dosing (DD) of oliceridine (0.35mg and 0.5mg) to those with morphine (1mg), using a decision tree with a 24-hour time horizon and sample population of 1,000 surgeries for each arm. Three common and costly ORAEs; respiratory depression (SpO₂<90%, RD), vomiting, and somnolence were utilized. Costs were enumerated as differences in cost of analgesics and resources utilized to manage the 3 ORAEs within 24 hours post-surgery. Risk ratios (RR) were based on AE rates observed in two controlled Phase-3 studies. RRs were then applied to AE rates observed in an open-label Phase-3 study of oliceridine to estimate AE incidence in real-world sample. Costs of all analgesics and antiemetics were tabulated based on rates observed in Phase-3 studies. Standard cost weights from national discharge data and literature-sources were used to estimate hospital budget impact & costs for each AE. Average price was set to $100/day for oliceridine and $15/day for morphine.

RESULTS :

Incremental cost of RD, vomiting and somnolence was estimated at $3,975, $1,035 and $991, respectively. Use of oliceridine resulted in greater medication expenditures vs. morphine ($127,181 vs $30,558). However, overall hospital costs resulting from resources for managing AEs were lower for oliceridine vs morphine ($528,424 vs $852, 429), with net savings of $324,005 for each 1,000 treated patients.

CONCLUSIONS :

Use of oliceridine vs morphine for postoperative pain is expected to increase pharmacy costs but have a favorable overall budget impact.