title: Potential economic impact on hospitalisations of the Palliative Care Clinical Studies Collaborative (PaCCSC) ketamine randomised controlled trial.
abstract: OBJECTIVE
  The aim of the present study was to estimate the potential healthcare cost savings associated with reduced prescribing of subcutaneous ketamine for the treatment of chronic cancer pain after publication of the Palliative Care Clinical Studies Collaborative (PaCCSC) ketamine randomised controlled trial (RCT), to provide further reasons to modify ketamine prescribing practice in this setting.
  
  
  METHODS
  Potential cost savings in this setting were estimated from a health system perspective using a 1-year impact model. The model was populated with estimates derived using an epidemiological approach informed by morbidity and prevalence data, the PaCCSC feasibility study, ketamine RCT and national ketamine utilisation survey results, as well as clinical opinion.
  
  
  RESULTS
  The total estimated annual hospitalisation costs associated with subcutaneous ketamine prescribing were A$3 899 600 (2605 bed-days). A 17% reduction in ketamine prescribing lowered hospitalisation costs to A$3 236 668 (2162 bed-days), a reduction of A$662 932 (443 bed-days) because of reduced in-patient stays associated with ketamine toxicity and prescribing process.
  
  
  CONCLUSIONS
  The findings from the modelled impact analysis suggest that dissemination of the PaCCSC ketamine RCT results may have saved the Australian healthcare system approximately A$663 000 in annual hospitalisation costs and freed up 443 in-patient bed-days, although there was high uncertainty within the study. Wider dissemination over time and targeted, local de-adoption strategies could result in further savings.
authors.affiliation: Palliative Care Clinical Studies Collaborative (PaCCSC) & Flinders Health Economics Group, Flinders University, Room 55, Level 1, Block A, Repatriation General Hospital, Daws Road, Daw Park, SA 5041, Australia.
authors.forename: Nikki
authors.initials: N
authors.lastname: McCaffrey
authors.affiliation: Mater Research Institute - The University of Queensland, and The Department of Palliative and Supportive Care, Mater Health Services, South Brisbane, QLD 4101, Australia. Email.
authors.forename: Janet
authors.initials: J
authors.lastname: Hardy
authors.affiliation: Palliative Care Clinical Studies Collaborative (PaCCSC), Palliative and Supportive Services, Flinders University, 700 Goodwood Road, Daw Park, SA 5041, Australia. Email:.
authors.forename: Belinda
authors.initials: B
authors.lastname: Fazekas
authors.affiliation: Ingham Institute of Applied Medical Research, Locked Bag 82, Wetherill Park, NSW 1851, Australia. Email.
authors.forename: Meera
authors.initials: M
authors.lastname: Agar
authors.affiliation: Palliative Care Clinical Studies Collaborative (PaCCSC), Palliative and Supportive Services, Flinders University, 700 Goodwood Road, Daw Park, SA 5041, Australia. Email:.
authors.forename: Linda
authors.initials: L
authors.lastname: Devilee
authors.affiliation: Repatriation General Hospital, Daws Road, Daw Park, SA 5044, Australia. Email.
authors.forename: Debra
authors.initials: D
authors.lastname: Rowett
authors.affiliation: Palliative & Supportive Care, Flinders University, Bedford Park, SA 5042, Australia. Email.
authors.forename: David
authors.initials: D
authors.lastname: Currow
mesh_terms: D000700:Analgesics / Q000191:economics / Q000627:therapeutic use*; D002908:Chronic Disease; D017046:Cost Savings / Q000191:economics; D006760:Hospitalization; D006801:Humans; D007649:Ketamine / Q000191:economics / Q000627:therapeutic use*; D009369:Neoplasms / Q000503:physiopathology; D059408:Pain Management; D010166:Palliative Care / Q000191:economics*; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic
chemical_list: D000700:Analgesics; D007649:Ketamine