title: Cost-effectiveness analysis of levobupivacaine 0.5 %, a local anesthetic, infusion in the surgical wound after modified radical mastectomy.
abstract: OBJECTIVE
  Effective treatment of postoperative pain contributes to decreasing the rate of complications as well as the total cost of the operated patients. The aim of this study was to analyze the costs and the efficiency of use of continuous infusion of levobupivacaine 0.5 % with the help of an infusion pump in modified radical mastectomy.
  
  
  METHODS
  A cost calculation of the analgesic procedures (continuous infusion of levobupivacaine 0.5 % [levobupivacaine group (LG)] or saline [saline group (SG)] (2 ml/h 48 h) has been carried out based on the data of a previous clinical trial (double-blind randomized study) of patients who underwent modified radical mastectomy surgery. The measure of the effectiveness was the point reduction of pain derived from the verbal numeric rating scale (VNRS). The usual incremental cost-effectiveness ratio (ICER) was performed.
  
  
  RESULTS
  Considering only the intravenous analgesia, overall costs were lower in LG, as less analgesia was used (EUR14.06 ± 7.89 vs. 27.47 ± 14.79; p < 0.001). In this study the costs of the infusion pump were not calculated as it was used by both groups and they offset each other. However, if the infusion pump costs were included, costs would be higher in the LG, (EUR91.89 ± 7.89 vs. 27.47 ± 14.79; p < 0.001) and then the ICER was -8.51, meaning that for every extra point of decrease in the pain verbal numerical rating score over the 2-day period, the cost increased by EUR8.51.
  
  
  CONCLUSIONS
  Infiltration of local anesthetics is an effective technique for controlling postoperative pain and the associated added costs are relatively low in relation to the total cost of mastectomy, therefore providing patients with a higher quality of care in the prevention of pain.
  
  
  BACKGROUND
  clinicaltrials.gov: reference number NCT01389934. http://clinicaltrials.gov/show/NCT01389934
authors: Department of Anesthesiology and Postoperative Care, San Peter Hospital, Logroño, Spain, mlferreiralaso@gmail.com.
authors: Lourdes
authors: L
authors: Ferreira Laso
authors: Amanda
authors: A
authors: López Picado
authors: Fernando
authors: F
authors: Antoñanzas Villar
authors: Laura
authors: L
authors: Lamata de la Orden
authors: Mar
authors: M
authors: Ceballos Garcia
authors: Carolina
authors: C
authors: Ibañez López
authors: Lorena
authors: L
authors: Pipaon Ruilope
authors: Felix
authors: F
authors: Lamata Hernandez
authors: Cesar
authors: C
authors: Valero Martinez
authors: Felipe
authors: F
authors: Aizpuru
authors: Roberto
authors: R
authors: Hernandez Chaves
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000191:economics; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D015411:Mastectomy, Modified Radical / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine