Budget impact analysis for oliceridine in the management of moderate to severe acute postoperative pain

Use of conventional opioids for postoperative pain are associated with adverse events (ORAEs) that can affect health outcomes, compromising analgesia. Oliceridine, a new class of μ-opioid receptor IV agonist , is selective for G-protein signaling (achieving analgesia) with limited recruitment of β-arrestin (associated with ORAEs). Here we estimate the budget impact of oliceridine vs morphine for postoperative pain. We compared costs & outcomes of patients managed with demand dosing (DD) of oliceridine (0.35mg and 0.5mg) to those with morphine (1mg), using a decision tree with a 24-hour time horizon and sample population of 1,000 surgeries for each arm. Three common and costly ORAEs; respiratory depression (SpO2<90%, RD), vomiting, and somnolence were utilized. Costs were enumerated as differences in cost of analgesics and resources utilized to manage the 3 ORAEs within 24 hours post-surgery. Risk ratios (RR) were based on AE rates observed in two controlled Phase-3 studies. RRs were then applied to AE rates observed in an open-label Phase-3 study of oliceridine to estimate AE incidence in real-world sample. Costs of all analgesics and antiemetics were tabulated based on rates observed in Phase-3 studies. Standard cost weights from national discharge data and literature-sources were used to estimate hospital budget impact & costs for each AE. Average price was set to $100/day for oliceridine and $15/day for morphine. Incremental cost of RD, vomiting and somnolence was estimated at $3,975, $1,035 and $991, respectively. Use of oliceridine resulted in greater medication expenditures vs. morphine ($127,181 vs $30,558). However, overall hospital costs resulting from resources for managing AEs were lower for oliceridine vs morphine ($528,424 vs $852, 429), with net savings of $324,005 for each 1,000 treated patients. Use of oliceridine vs morphine for postoperative pain is expected to increase pharmacy costs but have a favorable overall budget impact.