(1126) Prescribing less than or greater than 150 MME after cesarean delivery: A cost effectiveness analysis

Friday, January 31, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Neha Mishra, BS (she/her/hers)

Medical Student
Oregon Health and Science University
Portland, Oregon, United States

Coauthor(s)

Megha Arora, BS

MD-MPH Student
Oregon Health & Science University
Portland, OR, United States
Aaron B. Caughey, MD, PhD

Professor and Chair
Oregon Health & Science University
Portland, Oregon, United States

Objective: Cesarean delivery is the most common major surgery performed in the United States, with an estimated 1,178,066 cesareans performed in 2022 alone. Current standards for postoperative pain management of cesarean deliveries include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) combined with opioids for breakthrough pain. Despite increased caution around the over-prescription of opioids, more than 75% of post-cesarean patients fill an opioid prescription with wide variances in dosing. Previous studies indicate higher rates of adverse outcomes for opioid prescriptions exceeding 150 morphine milligram equivalents(MME). In this study, we evaluated cost-effectiveness of prescribing greater than or less than 150 MME(e.g. 20 oxycodone tablets, 5 mg each) on developing an opioid use disorder (OUD), overdose, and opioid-related death.

Study Design:
We constructed a decision-analytic model to compare outcomes between receiving greater than 150 MME and less than 150 MME. Our theoretical cohort included 1,178,066 individuals, the number of cesareans performed in 2022. Outcomes were development of an OUD, overdose, opioid use-related death, costs, and quality adjusted life years (QALYs). We used a willingness-to-pay for the incremental cost-effectiveness ratio of $100,000/QALY. Model inputs were derived from the literature and assessed with sensitivity analyses.

Results: In our cohort, prescribing less than 150 MME was associated with 1587 fewer cases of developing an OUD. Prescribing less than 150 MME was cost-effective with an ICER of $8.94/QALY. In one way sensitivity analysis, receiving greater than 150 MME would only be cost effective if the probability of developing an OUD were below 0.005, above this probability, prescribing less than 150 MME is the only cost effective strategy.

Conclusion:
In our study, prescribing less than 150 MME was a cost-effective strategy to improve outcomes and minimize the adverse events associated with opioid prescription. Adopting a standard of prescribing less than 150 MME post-cesarean delivery would be advantageous for recovery of patients and the health system.