title: Cost-effectiveness of intravenous acetaminophen for pediatric tonsillectomy.
abstract: OBJECTIVE
  The primary outcome of this study was to examine the cost-effectiveness of the intraoperative combination of intravenous (IV) acetaminophen and IV opioids, versus IV opioids alone, as a part of an inhalational anesthetic technique for tonsillectomy in children.
  
  
  METHODS
  We used Decision Maker® software to construct and analyze a decision analytic model. Base-case and sensitivity analyses were performed. We studied the use of rescue analgesics in the postanesthesia care unit (PACU), adverse effects of acetaminophen and opioids, and costs associated with adverse effects. Costs were in 2013 US dollars, and effectiveness was measured as frequency of avoiding the need for rescue analgesics. Direct medical costs included medication, equipment, supplies, and labor associated with the treatment of adverse events from pain medications. Medication costs assumed single-dose vials.
  
  
  RESULTS
  In the base case, IV acetaminophen in combination with opioids was both less costly ($17.12) and more effective (3.3% fewer rescue events). In sensitivity analyses, the combination strategy remained cost-effective as long as the frequency of rescue analgesic administration was less than that in the opioid-alone strategy. Although medication costs of the combination strategy were higher, the overall costs were less than the competing strategy due to reduced adverse effects and reduced time spent in PACU.
  
  
  CONCLUSIONS
  The routine use of IV acetaminophen as an adjuvant to IV opioids for tonsillectomy with or without adenoidectomy in children aged <17 years should be considered as a means to reduce the need for rescue analgesia and in turn reduce costs.
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Subramanyam
authors.forename: Anna
authors.initials: A
authors.lastname: Varughese
authors.forename: Charles Dean
authors.initials: CD
authors.lastname: Kurth
authors.forename: Mark H
authors.initials: MH
authors.lastname: Eckman
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002648:Child; D003362:Cost-Benefit Analysis / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage; D007262:Infusions, Intravenous; D007430:Intraoperative Care / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D008297:Male; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000191:economics / Q000517:prevention & control; D010372:Pediatrics / Q000191:economics / Q000379:methods; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D012984:Software; D014068:Tonsillectomy / Q000379:methods*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine; D004091:Hydromorphone; D005283:Fentanyl
keywords: adverse events; cost savings; cost-effectiveness; decision analysis; intravenous acetaminophen; tonsillectomy