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The impact of intravenous acetaminophen pricing on opioid utilization and outcomes for children with appendicitis
Elaa M Mahdi1, Shadassa Ourshalimian1, David Darcy1
1Division of Pediatric Surgery, Children's Hospital Los Angeles, CA Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
Insights
Despite a price increase, intravenous acetaminophen use rose in children undergoing appendectomy, with lower pharmacy costs and decreased opioid use. This suggests broader use of IV acetaminophen to minimize postoperative opioid requirements.
Area of Science:
- Pediatric Surgery
- Pharmacoeconomics
- Pain Management
Background:
- The cost of intravenous acetaminophen significantly increased in 2014.
- This study investigates the impact of this price hike on its utilization and associated opioid use in pediatric appendectomy patients.
Purpose of the Study:
- To determine if increased intravenous acetaminophen cost affected its use and opioid consumption in children post-appendectomy.
- To analyze trends in intravenous acetaminophen utilization, opioid use, and pharmacy costs.
Main Methods:
- A multicenter retrospective cohort study analyzed data from 46 US children's hospitals (2011-2017).
- Included were 110,019 children aged 2-18 years undergoing appendectomy.
- Multivariable mixed-effects modeling assessed associations between intravenous acetaminophen, opioid use, and length of stay.
Main Results:
- Intravenous acetaminophen use increased from 3% to 40.1% by 2017, despite the price rise.
- Adjusted pharmacy charges decreased post-2014 for patients receiving IV acetaminophen.
- Postoperative opioid use declined from 73.6% to 58.6% in children staying at least one day.
Conclusions:
- Intravenous acetaminophen use continued to grow post-price increase, albeit at a reduced rate.
- Lower pharmacy costs and decreased opioid use were observed, suggesting IV acetaminophen's value in minimizing opioid needs.
- Findings support broader use of IV acetaminophen to manage pain and reduce opioid reliance after pediatric appendectomy.
Background:
In 2014, the price of intravenous acetaminophen more than doubled. This study determined whether increased intravenous acetaminophen cost was associated with decreased utilization and increased opioid use for children undergoing appendectomy.
Methods:
A multicenter retrospective cohort study using the Pediatric Health Information System database between 2011 and 2017 was performed. Healthy children 2 to 18 years undergoing appendectomy at 46 children's hospitals in the United States were identified. Intravenous acetaminophen use, opioid use, and pharmacy costs were assessed. Multivariable mixed-effects modeling was used to determine the association between postoperative opioid use, intravenous acetaminophen use, and postoperative length-of-stay.
Results:
Overall, 110,019 children undergoing appendectomy were identified, with 22.5% (N = 24,777) receiving intravenous acetaminophen. Despite the 2014 price increase, intravenous acetaminophen use increased from 3% in 2011 to 40.1% in 2017 (P < .001), but at a significantly reduced rate. After 2014, adjusted median pharmacy charges decreased from $3,326.5 (interquartile range: $1,717.5-$6,710.8) to $3,264.1 (interquartile range: $1,782.8-$5,934.7, P < .001) for children who received intravenous acetaminophen. In 94,745 children staying ≥1 day after surgery, postoperative opioid use decreased from 73.6% in 2011 to 58.6% in 2017 (P < .001). Use of intravenous acetaminophen alone compared to opioids alone after surgery resulted in similar predicted mean postoperative length-of-stay.
Conclusion:
In children undergoing appendectomy, intravenous acetaminophen use continued to rise, but at a slower rate after a price increase. Furthermore, adjusted pharmacy charges were lower for children receiving intravenous acetaminophen, possibly secondary to a concurrent decrease in postoperative opioid use. These findings suggest intravenous acetaminophen may be more broadly used regardless of perceived costs to minimize opioid use after surgery.
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