title: A cost-effectiveness analysis of parecoxib in the management of postoperative pain in the Greek health care setting.
abstract: BACKGROUND
  Postoperative pain management represents a significant factor of morbidity and reduced quality of life for patients, as well as a situation that substantially increases perioperative costs. Available analgesia treatments improve patient outcomes and reduce resource use associated with pain management, although with varying costs and adverse effects.
  
  
  OBJECTIVE
  The aim of this analysis was to assess the costs and patient outcomes of parecoxib used in combination with opioids versus use of opioids alone (monotherapy) in the postoperative treatment of surgical patients in Greece.
  
  
  METHODS
  A model comparing parecoxib plus opioid treatment versus opioids alone was developed that simulated the first 3 days postsurgery. Clinical efficacy was based on a Phase III, randomized, double-blind, clinical trial that also provided the frequencies of the occurrence of clinically meaningful events (CMEs) related to opioid use for both treatment arms. Resource use associated with each CME was elicited via strictly structured questionnaire-based interviews conducted by a panel of experts (surgeons and anesthesiologists), and costs were determined from the perspective of Social Insurance in Greece (2012 euros). Treatment effectiveness was calculated in summed pain intensity scores. A series of 1-way sensitivity analyses were conducted to check the robustness of the outcomes.
  
  
  RESULTS
  Patients treated with parecoxib plus opioids had lower summed pain intensity scores (59.20 vs 80.80) and fewer CMEs (0.62 vs 1.04 per patient) compared with opioids alone for a 3-day period. This outcome led to a full offset of the excess cost of the addition of parecoxib and led to potential savings of €858 per patient compared with opioid use alone. Savings were mainly attributable to decreased CMEs due to reduced intensive care unit and general ward bed-days as well as to reduced physician and nurse time. Results were sensitive with regard to probabilities of occurrence or co-occurrence of CMEs (≥2 CMEs occurring simultaneously), although only to a small extent. Medication costs had a minimal impact on the results of the sensitivity analysis.
  
  
  CONCLUSIONS
  Parecoxib may be a useful addition to opioid treatment by improving postoperative analgesic management, reducing opioid-related adverse events, and lowering per-patient treatment costs.
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece. kathanasakis@esdy.edu.gr
authors.forename: Kostas
authors.initials: K
authors.lastname: Athanasakis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Petrakis
authors.forename: Elli
authors.initials: E
authors.lastname: Vitsou
authors.forename: Apostolia
authors.initials: A
authors.lastname: Pimenidou
authors.forename: John
authors.initials: J
authors.lastname: Kyriopoulos
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017326:Clinical Trials, Phase III as Topic; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006115:Greece; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D007555:Isoxazoles; C409945:parecoxib
keywords: analgesia; cost-effectiveness analysis; opioids; parecoxib; postoperative pain