The cost-effectiveness of patient-controlled analgesia vs. standard care in patients presenting to the Emergency Department in pain, who are subsequently admitted to hospital

Benger, J.; Hayward, Chris; Pritchard, Colin; Smith, J. E.; Creanor, Siobhan; Squire, R.; Barton, Andrew; Cocking, Laura; Ewings, Paul; Rockett, Mark

Abstract

© 2017 The Association of Anaesthetists of Great Britain and Ireland The clinical effectiveness of patient-controlled analgesia has been demonstrated in a variety of settings. However, patient-controlled analgesia is rarely utilised in the Emergency Department. The aim of this study was to compare the cost-effectiveness of patient-controlled analgesia vs. standard care in participants admitted to hospital from the Emergency Department with pain due to traumatic injury or non-traumatic abdominal pain. Pain scores were measured hourly for 12 h using a visual analogue scale. Cost-effectiveness was measured as the additional cost per hour in moderate to severe pain avoided by using patient-controlled analgesia rather than standard care (the incremental cost-effectiveness ratio). Sampling variation was estimated using bootstrap methods and the effects of parameter uncertainty explored in a sensitivity analysis. The cost per hour in moderate or severe pain averted was estimated as £24.77 (€29.05, US$30.80) (bootstrap estimated 95%CI £8.72 to £89.17) for participants suffering pain from traumatic injuries and £15.17 (€17.79, US$18.86) (bootstrap estimate 95%CI £9.03 to £46.00) for participants with non-traumatic abdominal pain. Overall costs were higher with patient-controlled analgesia than standard care in both groups: pain from traumatic injuries incurred an additional £18.58 (€21.79 US$23.10) (95%CI £15.81 to £21.35) per 12 h; and non-traumatic abdominal pain an additional £20.18 (€23.67 US$25.09) (95%CI £19.45 to £20.84) per 12 h.

• Journal Article Type: Article
• Acceptance Date: Apr 11, 2017
• Online Publication Date: May 26, 2017
• Publication Date: Aug 1, 2017
• Deposit Date: Jun 20, 2017
• Journal: Anaesthesia
• Print ISSN: 0003-2409
• Electronic ISSN: 1365-2044
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 72
• Issue: 8
• Pages: 953-960
• DOI: https://doi.org/10.1111/anae.13932
• Keywords: cost-effectiveness, patient-controlled analgesia, standard care, patients, emergency department, pain, admitted, hospital
• Public URL: https://uwe-repository.worktribe.com/output/883558
• Publisher URL: http://dx.doi.org/10.1111/anae.13932
• Contract Date: Jun 20, 2017