Opioid-Induced Constipation: Can Your Hospital Afford the Financial Burden?

MedicalResearch.com Interview with:

Howard Franklin, MD, MBAVice President of Medical Affairs and StrategySalix Pharmaceuticals

Dr. Franklin

Howard Franklin, MD, MBA
Vice President of Medical Affairs and Strategy
Salix Pharmaceuticals

MedicalResearch.com: What is opioid-induced constipation?

Response: Opioid-induced constipation (OIC) is a side effect in as many as 80 percent of chronic pain patients on opioids. OIC is unlikely to improve over time without treatment and can lead to suffering and discomfort. More importantly, the insufficient treatment of OIC can have negative implications for patients, both those on opioid therapy for chronic non-cancer pain as well as advanced illness, and for hospitals. 

MedicalResearch.com: What are potential patient complications of OIC? How does this impact hospitals? 

Response: Serious complications of OIC may include hemorrhoid formation, rectal pain and burning, fecal impaction, overflow diarrhea, pseudo-obstruction, aspiration and bowel perforation.

In the hospital setting, the economic impact is substantially higher in patients with opioid-induced constipation. Uncontrolled OIC means longer hospital stays, increased emergency department (ED) visits and increased number of readmissions due to uncontrolled OIC that may negatively impact a hospital’s quality scores.

Salix Pharmaceuticals is making efforts to highlight the financial burden for patients with OIC and for hospitals through an analysis of the cost of OIC in patients on opioid therapy for chronic pain as well as patients with advanced illness. 

MedicalResearch.com: What were the results of the analyses on the financial burden for patients with OIC and for hospitals?

Response: The first analysis found that for hospital in-patients with chronic non-cancer pain without opioid-induced constipation, the average hospital stay costs $1,852 – while for those with OIC, the cost is $5,847. The average time spent in the hospital was one day for an elderly patient without constipation and four days for one experiencing constipation. It is also clear that OIC strains hospital resources, causing a 63 percent increase in the mean number of emergency room visits and a 48 percent increase in one or more emergency room visits.

A second analysis found that the financial impact for cancer patients on opioids who had constipation were increased more than cancer patients not taking opioids. For instance, the total cost of a cancer patient without OIC cost approximately $26,911 versus $52,216 for a patient with opioid-induced constipation. The hospital stay for a cancer patient was 10 days without constipation and 19 days with constipation. Additionally, these patients account for a 101 percent increase in the mean number of emergency room visits and a 57 percent increase in one or more emergency room visits.

MedicalResearch.com: How can hospital clinicians better address OIC to try and reduce the financial burden?

Response: Given the data above which shows constipation is a risk for patients and a financial burden on hospitals – especially in cancer patients on opioids and in non-cancer patients with OIC –physicians must do a better job at recognizing various types of constipation and treating its symptoms appropriately. While the typical, first-line treatment for constipation is laxatives, they are often insufficient. They do not effectively target the underlying cause of opioid-induced constipation, which is the binding of opioids to mu-opioid receptors in the gut. Due to this, we need to isolate the cause of constipation in patients by targeting the underlying cause of OIC separately. When OIC is present, there are many effective treatment options, including peripherally-acting mu-opioid receptor antagonists (PAMORAs).

For patients who are on opioid therapy but haven’t been diagnosed with OIC, it is equally as important to continuously assess them. And, patients should be educated about the side effects of opioid therapy – including opioid-induced constipation – and encouraged to speak up prior to discharge in order to plan for care at home and to avoid ED visits and readmissions. 

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