Abstract
Introduction:
Elderly patients are susceptible to opioid-induced constipation (OIC) and often remain constipated despite regular laxative prescription. Naloxegol is a gastrointestinal opioid antagonist licensed for OIC in patients failing laxative therapy. Naloxegol’s higher unit price than standard laxatives may disincentivise hospital pharmacies from stocking and supplying it. We present a quality improvement project and cost-analysis on the use of naloxegol in treating OIC in the real-world setting of a post-operative geriatric ward.
Methods:
Initial audit-
Review of inpatient notes from October-November 2022 identified patients on opioids who failed laxative therapy during admission (bowels not opening for ≥3 days, despite 4 consecutive days of laxatives). Number of bowel motions per week following failure of laxatives and number of laxative doses received were recorded. Total cost of laxatives was calculated for each patient.
Intervention -
From December 2022-January 2023, naloxegol was given to patients with OIC failing laxative therapy. Laxatives were stopped on receipt of naloxegol.
Results:
Baseline audit identified 63.9% patients on opioids had failed laxative therapy. Following laxative therapy failure, average number of bowel motions/week was 2.65. Accounting for length of admission, average cost of laxatives per patient per day was £0.13.
During the intervention period 67.2% patients on opioids failed laxative therapy. 13 were prescribed naloxegol. Average number of bowel motions on naloxegol was 5.1/week. Average combined cost of laxatives and naloxegol per patient per day was £0.71.
Conclusions:
We demonstrate that naloxegol is effective in treating OIC in those failing laxative therapy, at an average cost of £0.58 per patient per day more than those on standard laxative regimes. While difficult to quantify, constipation is detrimental to patient experience and recovery and incurs indirect costs. On balance, we believe this cost margin to be acceptable, and naloxegol a beneficial treatment for OIC in geriatric patients failing laxative therapy.