title: Epidural analgesia versus patient-controlled analgesia for pain relief in uterine artery embolization for uterine fibroids: a decision analysis.
abstract: OBJECTIVE
  This study was designed to compare the costs and effects of epidural analgesia (EDA) to those of patient-controlled intravenous analgesia (PCA) for postintervention pain relief in women having uterine artery embolization (UAE) for systematic uterine fibroids.
  
  
  METHODS
  Cost-effectiveness analysis (CEA) based on data from the literature by constructing a decision tree to model the clinical pathways for estimating the effects and costs of treatment with EDA and PCA. Literature on EDA for pain-relief after UAE was missing, and therefore, data on EDA for abdominal surgery were used. Outcome measures were compared costs to reduce one point in visual analogue score (VAS) or numeric rating scale (NRS) for pain 6 and 24 h after UAE and risk for complications.
  
  
  RESULTS
  Six hours after the intervention, the VAS was 3.56 when using PCA and 2.0 when using EDA. The costs for pain relief in women undergoing UAE with PCA and EDA were <euro>191 and <euro>355, respectively. The costs for EDA to reduce the VAS score 6 h after the intervention with one point compared with PCA were <euro>105 and <euro>179 after 24 h. The risk of having a complication was 2.45 times higher when using EDA.
  
  
  CONCLUSIONS
  The results of this indirect comparison of EDA for abdominal surgery with PCA for UAE show that EDA would provide superior analgesia for post UAE pain at 6 and 24 h but with higher costs and an increased risk of complications.
authors.affiliation: Department of Gynaecology, Academic Medical Centre, Meibergdreef 9, 1105, Amsterdam, The Netherlands. s.m.vanderkooij@amc.uva.nl.|Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands. s.m.vanderkooij@amc.uva.nl.
authors.forename: Sanne M
authors.initials: SM
authors.lastname: van der Kooij
authors.affiliation: Department of Gynaecology, Academic Medical Centre, Meibergdreef 9, 1105, Amsterdam, The Netherlands.
authors.forename: Lobke M
authors.initials: LM
authors.lastname: Moolenaar
authors.affiliation: Department of Gynaecology, Academic Medical Centre, Meibergdreef 9, 1105, Amsterdam, The Netherlands.
authors.forename: Willem M
authors.initials: WM
authors.lastname: Ankum
authors.affiliation: Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Jim A
authors.initials: JA
authors.lastname: Reekers
authors.affiliation: Department of Gynaecology, Academic Medical Centre, Meibergdreef 9, 1105, Amsterdam, The Netherlands.
authors.forename: Ben Willem J
authors.initials: BWJ
authors.lastname: Mol
authors.affiliation: Department of Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Wouter J K
authors.initials: WJK
authors.lastname: Hehenkamp
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000191:economics / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis / Q000379:methods / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*; D014594:Uterine Neoplasms / Q000628:therapy*