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Budget Impact and Cost-Effectiveness of Intravenous Meloxicam to Treat Moderate–Severe Postoperative Pain

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Abstract

Introduction

This study assesses the budget impact and cost-effectiveness of intravenous meloxicam (MIV) to treat moderate–severe acute postoperative pain in adults.

Methods

A two-part Markov cohort model captured the pharmacoeconomic impact of MIV versus non-opioid intravenous analgesics (acetaminophen, ibuprofen, ketorolac) among a hypothetical adult cohort undergoing selected inpatient procedures and experiencing moderate–severe acute postoperative pain: Part 1 (postoperative hour 0 to discharge, cycled hourly), health states were defined by pain level. Pain transition rates, adverse event probabilities, and concomitant opioid utilization were derived from a network meta-analysis. Part 2 (discharge to week 52, cycled weekly), health states were defined by the presence/absence of pain-related readmission and opioid use disorder as determined by literature-based inputs relating to pain control outcomes. Healthcare utilization and direct medical costs were derived from an administrative claims database analysis. Primary outcomes were the incremental cost per member per month (PMPM) and cost per quality-adjusted life year (QALY) gained. Scenario, univariate, and probabilistic sensitivity analyses were conducted. The model assumed a private payer perspective in the USA (no discounting, 2019 US$).

Results

Modeled outcomes indicated MIV was associated with lower accumulated postoperative pain, fewer adverse events, and less opioid utilization for most procedures and comparators, with longer-term outcomes also generally favoring MIV. The budget impact of MIV was − $0.028 PMPM. From a cost-effectiveness perspective, MIV had lower costs and better outcomes for all comparisons except against ketorolac in orthopedic procedures where the former was cost-effective but not cost saving ($95,925/QALY). Scenario and sensitivity analyses indicated that modeled outcomes were robust to alternative inputs and underlying input uncertainty. Differences in direct medical costs were driven by reduced costs attributable to length of stay and opioid-related adverse drug events.

Conclusion

MIV was associated with modeled clinical and economic benefits compared to commonly used non-opioid intravenous analgesics.

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References

  1. Gross J, Gordon DB. The strengths and weaknesses of current US policy to address pain. Am J Public Health. 2019;109(1):66–72. https://doi.org/10.2105/AJPH.2018.304746.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Shaffer EE, Pham A, Woldman RL, et al. Estimating the effect of intravenous acetaminophen for postoperative pain management on length of stay and inpatient hospital costs. Adv Ther. 2017;33(12):2211–28. https://doi.org/10.1007/s12325-016-0438-y.

    Article  CAS  PubMed  Google Scholar 

  3. Kharasch ED, Brunt LM. Perioperative opioids and public health. Anesthesiology. 2016;124(4):960–5. https://doi.org/10.1097/ALN.0000000000001012.

    Article  PubMed  Google Scholar 

  4. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534–40. https://doi.org/10.1213/01.ANE.0000068822.10113.9E.

    Article  PubMed  Google Scholar 

  5. Correll DJ, Vlassakov KV, Kissin I. No evidence of real progress in treatment of acute pain, 1993–2012: scientometric analysis. J Pain Res. 2014;7:199–210. https://doi.org/10.2147/JPR.S60842.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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. 2018;153(8):757–63. https://doi.org/10.1001/jamasurg.2018.1039.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Althaus A, Arránz Becker O, Neugebauer E. Distinguishing between pain intensity and pain resolution: using acute post-surgical pain trajectories to predict chronic post-surgical pain. Eur J Pain. 2014;18(4):513–21. https://doi.org/10.1002/j.1532-2149.2013.00385.x.

    Article  CAS  PubMed  Google Scholar 

  8. Hernandez-Boussard T, Graham LA, Desai K, et al. The fifth vital sign: postoperative pain predicts 30-day readmissions and subsequent emergency department visits. Ann Surg. 2017;266(3):516–24. https://doi.org/10.1097/SLA.0000000000002372.

    Article  PubMed  Google Scholar 

  9. Morland R. Evolution of the national opioid crisis. Nursing. 2019;49(5):51–6. https://doi.org/10.1097/01.NURSE.0000554613.10524.54.

    Article  PubMed  Google Scholar 

  10. Roland CL, Ye X, Stevens V, Oderda GM. The prevalence and cost of medicare beneficiaries diagnosed and at risk for opioid abuse, dependence, and poisoning. J Manag Care Spec Pharm. 2019;25(1):18–27. https://doi.org/10.18553/jmcp.2019.25.1.018.

    Article  PubMed  Google Scholar 

  11. Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council [published correction appears in J Pain. 2016 Apr;17(4):508–10. Dosage error in article text]. J Pain. 2016;17(2):131–157. https://doi.org/10.1016/j.jpain.2015.12.008.

  12. Savarese JJ, Tabler NG Jr. Multimodal analgesia as an alternative to the risks of opioid monotherapy in surgical pain management. J Healthc Risk Manag. 2017;37(1):24–30. https://doi.org/10.1002/jhrm.21262.

    Article  PubMed  Google Scholar 

  13. Hansen RN, Pham A, Strassels SA, Balaban S, Wan GJ. Erratum to: Comparative analysis of length of stay and inpatient costs for orthopedic surgery patients treated with IV acetaminophen and IV opioids vs. IV opioids alone for post-operative pain. Adv Ther. 2016;33(9):1646–8. https://doi.org/10.1007/s12325-016-0400-z.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg. 2017;152(7):691–7. https://doi.org/10.1001/jamasurg.2017.0898.

    Article  PubMed  Google Scholar 

  15. Wardhan R, Chelly J. Recent advances in acute pain management: understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy. F1000Res. 2017;6:2065. https://doi.org/10.12688/f1000research.12286.1.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging Dis. 2018;9(1):143–50. https://doi.org/10.14336/AD.2017.0306.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Christensen SE, Cooper SA, Mack RJ, McCallum SW, Du W, Freyer A. A randomized double-blind controlled trial of intravenous meloxicam in the treatment of pain following dental impaction surgery. J Clin Pharmacol. 2018;58(5):593–605. https://doi.org/10.1002/jcph.1058.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Rechberger T, Mack RJ, McCallum SW, Du W, Freyer A. Analgesic efficacy and safety of intravenous meloxicam in subjects with moderate-to-severe pain after open abdominal hysterectomy: a phase 2 randomized clinical trial. Anesth Analg. 2019;128(6):1309–18. https://doi.org/10.1213/ANE.0000000000003920.

    Article  CAS  PubMed  Google Scholar 

  19. Gottlieb IJ, Tunick DR, Mack RJ, et al. Evaluation of the safety and efficacy of an intravenous nanocrystal formulation of meloxicam in the management of moderate-to-severe pain after bunionectomy. J Pain Res. 2018;11:383–93. https://doi.org/10.2147/JPR.S149879.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Pollak RA, Gottlieb IJ, Hakakian F, et al. Efficacy and safety of intravenous meloxicam in patients with moderate-to-severe pain following bunionectomy: a randomized, double-blind, placebo-controlled trial. Clin J Pain. 2018;34(10):918–26. https://doi.org/10.1097/AJP.0000000000000609.

    Article  PubMed  Google Scholar 

  21. Singla N, Bindewald M, Singla S, et al. Efficacy and safety of intravenous meloxicam in subjects with moderate-to-severe pain following abdominoplasty. Plast Reconstr Surg Glob Open. 2018;6(6):e1846. https://doi.org/10.1097/GOX.0000000000001846.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bergese SD, Melson TI, Candiotti KA, et al. A phase 3, randomized, placebo-controlled evaluation of the safety of intravenous meloxicam following major surgery [published correction appears in Clin Pharmacol Drug Dev. 2020 Aug;9(6):774]. Clin Pharmacol Drug Dev. 2019;8(8):1062–72. https://doi.org/10.1002/cpdd.666.

  23. Viscusi ER, Gan TJ, Bergese S, et al. Intravenous meloxicam for the treatment of moderate to severe acute pain: a pooled analysis of safety and opioid-reducing effects. Reg Anesth Pain Med. 2019;44(3):360–8. https://doi.org/10.1136/rapm-2018-100184.

    Article  PubMed  Google Scholar 

  24. Weinstein MC, O’Brien B, Hornberger J, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices-Modeling Studies. Value Health. 2003;6(1):9–17. https://doi.org/10.1046/j.1524-4733.2003.00234.x.

    Article  PubMed  Google Scholar 

  25. Caro JJ, Briggs AH, Siebert U, Kuntz KM, ISPOR-SMDM Modeling Good Research Practices Task Force. Modeling good research practices—overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-1. Med Decis Mak. 2012;32(5):667–77. https://doi.org/10.1177/0272989X12454577.

    Article  Google Scholar 

  26. O’Mahony JF, Newall AT, van Rosmalen J. Dealing with time in health economic evaluation: methodological issues and recommendations for practice. Pharmacoeconomics. 2015;33(12):1255–68. https://doi.org/10.1007/s40273-015-0309-4.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kwong WJ, Ozer-Stillman I, Miller JD, Haber NA, Russell MW, Kavanagh S. Cost-effectiveness analysis of tapentadol immediate release for the treatment of acute pain. Clin Ther. 2010;32(10):1768–81. https://doi.org/10.1016/j.clinthera.2010.09.011.

    Article  PubMed  Google Scholar 

  28. Tilleul P, Aissou M, Bocquet F, et al. Cost-effectiveness analysis comparing epidural, patient-controlled intravenous morphine, and continuous wound infiltration for postoperative pain management after open abdominal surgery. Br J Anaesth. 2012;108(6):998–1005. https://doi.org/10.1093/bja/aes091.

    Article  CAS  PubMed  Google Scholar 

  29. Athanasakis K, Petrakis I, Vitsou E, Pimenidou A, Kyriopoulos J. A cost-effectiveness analysis of parecoxib in the management of postoperative pain in the Greek health care setting. Clin Ther. 2013;35(8):1118–24. https://doi.org/10.1016/j.clinthera.2013.06.004.

    Article  PubMed  Google Scholar 

  30. Claims Analysis (Truven MarketScan 2015–2017): Data on File. Baudax Bio.

  31. Carter JA, Black LK, Sharma D, Bhagnani T, Jahr JS. Efficacy of non-opioid analgesics to control postoperative pain: a network meta-analysis. BMC Anesthesiol. 2020;20(1):272. https://doi.org/10.1186/s12871-020-01147-y.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Bhatnagar N, Lakshmi PV, Jeyashree K. Multiple treatment and indirect treatment comparisons: an overview of network meta-analysis. Perspect Clin Res. 2014;5(4):154–8. https://doi.org/10.4103/2229-3485.140550.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ. 2011;342: d549. https://doi.org/10.1136/bmj.d549.

    Article  PubMed  Google Scholar 

  34. Berkowitz RD. Safety and opioid use following major orthopedic surgery in a phase 3, placebo-controlled study of intravenous meloxicam. Poster presented at PAINWeek 2017; September 5–9, 2017. Las Vegas, NV. https://d1io3yog0oux5.cloudfron. Accessed 10 Nov 2017

  35. Singla NK, Desjardins PJ, Chang PD. A comparison of the clinical and experimental characteristics of four acute surgical pain models: dental extraction, bunionectomy, joint replacement, and soft tissue surgery. Pain. 2014;155(3):441–56. https://doi.org/10.1016/j.pain.2013.09.002.

    Article  PubMed  Google Scholar 

  36. IBM Micromedex RED BOOK. https://www.ibm.com/products/micromedex-red-book. Accessed 21 Dec 2019

  37. Palmer PP, Walker JA, Patanwala AE, Hagberg CA, House JA. Cost of intravenous analgesia for the management of acute pain in the emergency department is substantial in the United States. JHEOR. 2017;5(1):1–15.

    Article  Google Scholar 

  38. Wetherington S, Delong L, Kini S, et al. Pain quality of life as measured by utilities. Pain Med. 2014;15(5):865–70. https://doi.org/10.1111/pme.12405.

    Article  PubMed  Google Scholar 

  39. Mather RC 3rd, Koenig L, Acevedo D, et al. The societal and economic value of rotator cuff repair. J Bone Jt Surg Am. 2013;95(22):1993–2000. https://doi.org/10.2106/JBJS.L.01495.

    Article  Google Scholar 

  40. Christensen HN, Olsson U, From J, Breivik H. Opioid-induced constipation, use of laxatives, and health-related quality of life. Scand J Pain. 2016;11:104–10. https://doi.org/10.1016/j.sjpain.2015.12.007.

    Article  PubMed  Google Scholar 

  41. Kim S, Kim E, Suh HS. Cost-effectiveness of an opioid abuse-prevention program using the narcotics information management system in South Korea. Value Health. 2021;24(2):174–81. https://doi.org/10.1016/j.jval.2020.12.002.

    Article  PubMed  Google Scholar 

  42. CEA registry. http://healtheconomicsdev.tuftsmedicalcenter.org/cear2/search/search.aspx. Accessed 21 Dec 2019

  43. Burcher KM, Suprun A, Smith A. Risk factors for opioid use disorders in adult postsurgical patients. Cureus. 2018;10(5):e2611. https://doi.org/10.7759/cureus.2611.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kirson NY, Scarpati LM, Enloe CJ, Dincer AP, Birnbaum HG, Mayne TJ. The economic burden of opioid abuse: updated findings. J Manag Care Spec Pharm. 2017;23(4):427–45. https://doi.org/10.18553/jmcp.2017.16265.

    Article  PubMed  Google Scholar 

  45. Attema AE, Brouwer WBF, Claxton K. Discounting in economic evaluations. Pharmacoeconomics. 2018;36(7):745–58. https://doi.org/10.1007/s40273-018-0672-z.

    Article  PubMed  PubMed Central  Google Scholar 

  46. U.S. Department of Labor. Bureau of Labor Statistics. Consumer Price Index. All urban consumers, US medical care. 2019. https://data.bls.gov/cgi-bin/surveymost?cu. Accessed 1 Feb 2020

  47. Berkowitz RD, Steinfeld R, Sah AP, et al. Safety and efficacy of perioperative intravenous meloxicam for moderate-to-severe pain management in total knee arthroplasty: a randomized clinical trial. Pain Med. 2021;22(6):1261–71. https://doi.org/10.1093/pm/pnab016.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Mauskopf J, Earnshaw S. A methodological review of US budget-impact models for new drugs. Pharmacoeconomics. 2016;34(11):1111–31. https://doi.org/10.1007/s40273-016-0426-8.

    Article  PubMed  Google Scholar 

  49. Jahr JS, Searle S, McCallum S, et al. Platelet function: meloxicam intravenous in whole blood samples from healthy volunteers. Clin Pharmacol Drug Dev. 2020;9(7):841–8. https://doi.org/10.1002/cpdd.772.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Funding

Sponsorship and the journal’s Rapid Service Fee, and the open access charge for this study were funded by Baudax Bio, Inc.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author Contributions

All authors contributed to the design, conduct, and analysis of the study and manuscript preparation and review.

Medical Writing, Editorial, and Other Assistance

None.

Disclosures

Dr. Black is a consultant to Baudax Bio, Inc.. Dr. Deering is current employee of EPI-Q Inc. which received payment from Baudax Bio, Inc. associated with the development and execution of this study. Mr. Carter was a past employee at EPI-Q, Inc. Dr. Jahr is a Scientific Advisor to Baudax Bio, Inc. and has received honorarium from Baudax Bio, Inc.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

Data Availability

The model described in this report was developed using information drawn from published studies that are referenced herein. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Blue Point LLC, 711 Warrenville Road, Wheaton, IL, 60189-0000, USA

    John A. Carter

  2. Baudax Bio, Inc., 490 Lapp Road, Malvern, PA, USA

    Libby K. Black

  3. EPI-Q, Inc., 915 Harger Road, Oak Brook, IL, USA

    Kathleen L. Deering

  4. Professor Emeritus of Anesthesiology, David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, USA

    Jonathan S. Jahr

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  1. John A. Carter
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Correspondence to John A. Carter.

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Carter, J.A., Black, L.K., Deering, K.L. et al. Budget Impact and Cost-Effectiveness of Intravenous Meloxicam to Treat Moderate–Severe Postoperative Pain. Adv Ther 39, 3524–3538 (2022). https://doi.org/10.1007/s12325-022-02174-6

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