The impact of intravenous acetaminophen pricing on opioid ut
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In 2014, the price of intravenous acetaminophen more than doubled. Because of this the use of intravenous acetaminophen slowly increases in children undergoing an appendectomy.

This study by Surgery determined whether increased intravenous acetaminophen cost was associated with decreased utilization and increased opioid use for children undergoing an appendectomy.

A multicenter retrospective cohort study using the Pediatric Health Information System database was performed. Healthy children 2 to 18 years undergoing appendectomy hospitals in the United States were identified. Intravenous acetaminophen use, opioid use, and pharmacy costs were assessed. Multivariable mixed-effects modeling was used to determine the association between postoperative opioid use, intravenous acetaminophen use, and postoperative length-of-stay. Overall, 110,019 children undergoing appendectomy were identified, with 22.5% receiving intravenous acetaminophen.

--Despite the 2014 price increase, intravenous acetaminophen use increased from 3% in 2011 to 40.1% in 2017, but at a significantly reduced rate.

--After 2014, adjusted median pharmacy charges decreased from $3,326.5 to $3,264.1 for children who received intravenous acetaminophen.

--In 94,745 children staying ≥1 day after surgery, postoperative opioid use decreased from 73.6% in 2011 to 58.6% in 2017.

--Use of intravenous acetaminophen alone compared to opioids alone after surgery resulted in similar predicted mean postoperative length-of-stay.

In children undergoing appendectomy, intravenous acetaminophen use continued to rise, but at a slower rate after a price increase. Furthermore, adjusted pharmacy charges were lower for children receiving intravenous acetaminophen, possibly secondary to a concurrent decrease in postoperative opioid use. These findings suggest intravenous acetaminophen may be more broadly used regardless of perceived costs to minimize opioid use after surgery.