1641 NALOXEGOL USE IN A POST-OPERATIVE GERIATRIC WARD: A FEASIBLE, COST-EFFECTIVE TREATMENT FOR OPIOID-INDUCED CONSTIPATION

Abstract Introduction Elderly post-operative patients are susceptible to opiate-induced constipation (OIC) and many fail to open their bowels despite regular laxative prescription. Naloxegol is a gastrointestinal opiate antagonist licensed to treat OIC in patients failing laxative therapy. Naloxegol’s higher unit price than standard laxatives may present a barrier to its use by hospital pharmacies. We present a quality improvement project on the feasibility and cost-effectiveness of using of naloxegol to treat OIC in the real-world setting of a geriatric post-operative ward. Methods Initial Audit- Review of inpatient notes from October-November 2022 identified patients on opiates who failed laxative therapy during admission (bowels not opening for ≥3 days, despite 4 consecutive days of laxatives). Average number of bowel motions per week following failure of laxative therapy and number of laxative doses received were recorded. Total cost of laxatives was recorded for each patient. Intervention – Naloxegol was supplied to the ward for patients meeting criteria of OIC failing laxative therapy. From December 2022-January 2023, naloxegol was prescribed to these patients. Laxatives were stopped on receipt of naloxegol. Naloxegol was stopped on cessation of opiates. Results Baseline audit identified 63.9% patients on opiates had failed laxative therapy. Following laxative therapy failure, average number of bowel motions/week was 2.65. Average cost of laxatives per patient was £3.77. Accounting for length of admission, average cost of laxatives per day was £0.13. During the intervention period 67.2% patients on opiates failed laxative therapy. 13 patients were prescribed naloxegol. Average number of bowel motions on naloxegol was 5.1/week. Average combined cost of laxatives and naloxegol per patient was £1.93. Average combined cost of laxatives and naloxegol per day was £0.08. Conclusions In this small-scale quality improvement project we demonstrate that naloxegol is both clinically effective and cost-effective in treating OIC in geriatric post-operative patients failing laxative therapy.