[Postoperative multimodal pain management : Cost-minimisation analysis from a hospital's point of view].
BACKGROUND
Adequate pain management after major surgery is important to improve patients' quality of life and to support the healing process. Since the cost for pain management is included in the DRG system for hospital reimbursement, hospitals should aim to provide adequate postoperative pain management at the lowest possible cost. In this study we compare two multimodal pain management schemes for postoperative pain management in a cost-minimisation analysis.


METHODS
In a decision analytic model two treatment regimes for postoperative pain management are compared in a cost-minimisation analysis: diclofenac + morphine vs paracetamol vs morphine. The study is performed from the perspective of a public hospital. Due to the short time horizon costs are not discounted.


RESULTS
Assuming comparable effectiveness for adequate postoperative pain management, the expected value in the decision tree model for the combination diclofenac + morphine is 13.37 EUR and for the combination paracetamol + morphine 32.23 EUR, respectively. The results are robust under various one- and two-way sensitivity analyses.


CONCLUSIONS
With no contraindications given the combination diclofenac + morphine is more cost-effective for postoperative pain management after major surgery compared to paracetamol + morphine.
Bernschein
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Centrum für Integrierte Onkologie Köln-Bonn, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland. andreas.bernschein@uk-koeln.de
Redaèlli
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Stock
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D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003953:Diagnosis-Related Groups / Q000191:economics; D004008:Diclofenac / Q000191:economics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004469:Economics, Hospital; D005858:Germany; D006801:Humans; D009020:Morphine / Q000191:economics / Q000627:therapeutic use; D009294:Narcotics / Q000191:economics / Q000627:therapeutic use; D010149:Postoperative Pain / Q000191:economics / Q000628:therapy*; D012051:Reimbursement Mechanisms
D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics; D004008:Diclofenac; D009020:Morphine