Pharmaco-economic evaluation of a disposable patient-controlled analgesia device and intramuscular analgesia in surgical patients.
The present study contrasted the pharmaco-economics and analgesic efficacy of intramuscular (i.m.) opioid treatment with a parenteral disposable patient-controlled analgesia (PCA) system in two groups of 20 female patients (ASA I-II, aged 35-69 years) scheduled for abdominal hysterectomy. The PCA group received a continuous infusion of 1.5 mg h-1 piritramide, a mu-opioid receptor agonist, with incremental doses of 1.5 mg (lock-out interval = 15 min). The i.m. group received 0.3 mg kg-1 piritramide i.m. when requested by the patient with a minimum interval of 5 h. Pain intensity, sedation and the functional recovery of the patients were followed for 72 h post-operatively. The sum of pain intensity differences (SPID) was used as a measure of analgesic efficiency. Equipment and drug costs, and the demand on nursing time were recorded over 3 days post-operatively. The costs of PCA and i.m. therapies per patient were used to calculate the cost-benefit (cost of treatment vs. nursing time) and cost-effectiveness (cost of treatment vs. SPID) analyses. Both treatments initially provided comparable analgesia, but PCA was more efficient after 16 h and significantly reduced nursing time for pain treatment (PCA = 61 +/- 4 min, i.m. = 88 +/- 5 min; P < 0.001). Functional recovery was not different for either treatment. Cost analysis indicated a better cost-benefit ratio for the i.m. treatment (0.35 vs. 1.1 for PCA treatment), but a similar cost-effectiveness for both treatments (PCA = 1.9 Belgian Francs (BEF) unit-1 SPID; i.m. = 1.7 BEF unit-1 SPID).
D'Haese
J
J
Department of Anaesthesiology, Flemish Free University of Brussels Medical Centre, Belgium.
Vanlersberghe
C
C
Umbrain
V
V
Camu
F
F
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000191:economics / Q000295:instrumentation* / Q000451:nursing; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000704:Analysis of Variance; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D004209:Disposable Equipment / Q000191:economics*; D016527:Drug Costs; D017850:Economics, Pharmaceutical; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D007044:Hysterectomy; D007260:Infusion Pumps / Q000191:economics; D007262:Infusions, Intravenous / Q000191:economics / Q000295:instrumentation; D007273:Injections, Intramuscular / Q000191:economics / Q000295:instrumentation / Q000451:nursing; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000191:economics / Q000451:nursing / Q000517:prevention & control*; D010892:Pirinitramide / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D011446:Prospective Studies; D017450:Receptors, Opioid, mu / Q000819:agonists; D013997:Time Factors
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D017450:Receptors, Opioid, mu; D010892:Pirinitramide