PHARMACO-ECONOMIC EVALUATION OF A DISPOSABLE PATIENT-CONTROLLED ANALGESIA DEVICE AND INTRAMUSCULAR ANALGESIA IN SURGICAL PATIENTS

The present study contrasted the pharmaco-economics and analgesic effi cacy of intramuscular (i.m.) opioid treatment with a parenteral dispos able patient-controlled analgesia (PCA) system in two groups of 20 fem ale patients (ASA I-II, aged 35-69 years) scheduled for abdominal hyst erectomy. The PCA group received a continuous infusion of 1.5 mg h(-1) piritramide, a mu-opioid receptor agonist, with incremental doses of 1.5 mg (lock-out interval=15 min). The i.m. group received 0.3 mg kg(- 1) piritramide i.m. when requested by the patient with a minimum inter val of 5 h. Pain intensity, sedation and the functional recovery of th e patients were followed for 72 h post-operatively. The sum of pain in tensity differences (SPID) was used as a measure of analgesic efficien cy. Equipment and drug costs, and the demand on nursing time were reco rded over 3 days post-operatively. The costs of PCA and i.m. therapies per patient were used to calculate the cost-benefit (cost of treatmen t vs, nursing time) and cost-effectiveness (cost of treatment vs. SPID ) analyses. Both treatments initially provided comparable analgesia, b ut PCA was more efficient after 16 h and significantly reduced nursing time for pain treatment (PCA=61+/-4 min, i.m.=88+/-5 min; P<0.001). F unctional recovery was not different for either treatment. Cost analys is indicated a better cost-benefit ratio for the i.m. treatment (0.35 vs. 1.1 for PCA treatment), but a similar cost-effectiveness for both treatments (PCA=1.9 Belgian Francs (BEF) unit(-1) SPID; i.m.=1.7 BEF u nit(-1) SPID).