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Budget Impact and Cost-Effectiveness of Intravenous Meloxicam to Treat Moderate-Severe Postoperative Pain
John A Carter1, Libby K Black2, Kathleen L Deering3
1Blue Point LLC, 711 Warrenville Road, Wheaton, IL, 60189-0000, USA. jcarter@bluepointllc.org.
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.
Insights
Intravenous meloxicam (MIV) offers clinical and economic advantages for managing moderate-severe acute postoperative pain. This non-opioid analgesic demonstrated reduced pain, fewer adverse events, and lower healthcare costs compared to other intravenous options.
Area of Science:
- Pharmacoeconomics
- Health Services Research
- Pain Management
Background:
- Acute postoperative pain management is critical for patient recovery and healthcare resource utilization.
- Non-opioid intravenous analgesics are commonly used, but their comparative effectiveness and economic impact require detailed assessment.
- Intravenous meloxicam (MIV) presents a potential alternative for moderate-to-severe acute postoperative pain.
Purpose of the Study:
- To assess the budget impact of using MIV for moderate-severe acute postoperative pain in adults.
- To evaluate the cost-effectiveness of MIV compared to other non-opioid intravenous analgesics.
- To model long-term clinical and economic outcomes associated with MIV treatment.
Main Methods:
- A two-part Markov cohort model was developed from a US private payer perspective.
- Part 1 modeled hourly transitions based on pain levels, adverse events, and opioid use from a network meta-analysis.
- Part 2 modeled weekly transitions to assess readmissions and opioid use disorder, utilizing administrative claims data for healthcare utilization and costs.
Main Results:
- MIV demonstrated lower accumulated postoperative pain, reduced adverse events, and decreased opioid utilization across most comparisons.
- The budget impact of MIV was a cost saving of -$0.028 per member per month (PMPM).
- MIV was cost-effective, showing lower costs and better outcomes than most comparators, with cost savings driven by reduced length of stay and opioid-related adverse drug events.
Conclusions:
- Intravenous meloxicam (MIV) is associated with significant modeled clinical benefits, including reduced pain and opioid use.
- MIV offers economic advantages, presenting a cost-effective strategy compared to commonly used non-opioid intravenous analgesics.
- The findings support MIV as a valuable option for managing moderate-severe acute postoperative pain, improving both patient outcomes and healthcare economics.
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