Economic evaluations of acute pain service programs: a systematic review.
OBJECTIVE
The purpose was to review the literature on the economic benefits associated with Acute Pain Service (APS) programs systematically. APSs have received widespread acceptance and formal support from institutions and organizations, but little is known about its economic benefits.


METHODS
MEDLINE and other databases were searched for economic evaluations of APSs. The study characteristics and methodological quality was assessed using standardized tools. All costs were adjusted to 2005 US dollars.


RESULTS
Ten economic evaluations (involving 14,774 patients) were identified that met eligibility criteria. There were wide variations in study designs, methodological quality, and outcome measures. There was insufficient data to identify which APSs model (anesthesiologist-based/nursing support or nurse-based/anesthesiologist supervised) was more cost-effective. The cost of APSs for surgical patients from direct and indirect effects (improved pain management from education in patients not receiving APS) varied from $2.28 to $5.08/patient/d. The level of evidence to support the cost-savings associated with APSs (shorter duration of intensive care unit and hospital stays) were limited to partial economic analyses. There was insufficient evidence to draw conclusions about the cost-effectiveness and cost-benefit of APSs as the quality of life and patient's willingness to pay for an APS intervention were not measured, respectively. The overall quality of published economic evaluations of APSs was poor.


CONCLUSIONS
There is a lack of high-quality economic studies to support the cost-effectiveness and cost-benefits of APSs.
Lee
Anna
A
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China. annalee@cuhk.edu.hk
Chan
Simon
S
Chen
Phoon Ping
PP
Gin
Tony
T
Lau
Angel Sc
AS
D003363:Cost Control; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D006801:Humans; D009726:Nurses; D018710:Pain Clinics / Q000191:economics* / Q000458:organization & administration; D010149:Postoperative Pain / Q000188:drug therapy / Q000191:economics; D010820:Physicians; D011153:Population; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D016896:Treatment Outcome