title: Is it cost-effective to use a mucosal or paracervical block to relieve the pain and cramping from cryosurgery? A decision model.
abstract: BACKGROUND
  Cryosurgery is an effective treatment for cervical intraepithelial neoplasia, but it often causes pain and cramping. Both paracervical and mucosal blocks have been shown to provide relief from the pain and cramping associated with cryosurgery. The purpose of this article is to recommend the use of mucosal block, paracervical block, or no block on the basis of which procedure minimizes the costs of averting the pain and cramping that a woman experiences during cryosurgery.
  
  
  METHODS
  A decision model was constructed encompassing the options (mucosal block, paracervical block, or no block) that a physician has when performing cryosurgery. The 4 possible outcomes for a patient undergoing cryosurgery were diagrammed as: (1) no pain and no cramping; (2) only cramping; (3) only pain; and (4) both pain and cramping. Each of these outcomes was measured on a 200-mm horizontal visual analog scale. Costs were derived for cryosurgery from the office perspective. Sensitivity analyses were conducted to test the robustness of the analysis.
  
  
  RESULTS
  The base case analysis showed that the lowest cost per pain and cramping averted was for women who had a mucosal block before cryosurgery ($153.87), compared with women with a paracervical block ($183.24) and women with no block ($218.83).
  
  
  CONCLUSIONS
  A mucosal block is the most cost-effective method to avert the pain and cramping from cryosurgery in women who have taken a nonsteroidal anti-inflammatory drug before the procedure.
authors.affiliation: Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH, USA. Diane.Harper@Dartmouth.edu
authors.forename: D M
authors.initials: DM
authors.lastname: Harper
authors.forename: J L
authors.initials: JL
authors.lastname: Cobb
mesh_terms: D000773:Anesthesia, Obstetrical / Q000191:economics / Q000379:methods; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003452:Cryosurgery / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D003663:Decision Trees; D005260:Female; D006801:Humans; D009120:Muscle Cramp / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D009407:Nerve Block / Q000191:economics*; D010149:Postoperative Pain / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D002578:Uterine Cervical Dysplasia / Q000601:surgery*