An economic evaluation of pain therapy after hysterectomy - Patient-controlled analgesia versus regular intramuscular opioid therapy

Objectives: To assess the economics of patient-controlled analgesia (PCA) t reatment versus regular intramuscular (IM) injections of opioid analgesia f or pain management after hysterectomy. Methods: Cost-minimization analysis was used based on the comparable pain c ontrol results achieved in the two treatment groups. Observations were take n of treatment-related events with personnel (mostly nursing) lime implicat ions during the trial. Times were then associated with these events in an i ndependent study of personnel activity. Costs were linked by using average wage rates for the various personnel for the Montreal area during the time of the study. Drug and material costs were hospital acquisition costs for a ll items. The cost of the PCA pump itself was not included in the analysis. Several analyses were performed to test the sensitivity of the results to various assumptions. Results: The results for total costs of the two therapies generally showed PCA to be more costly than regular IM injections despite no costs of the pu mp being included in the analyses. These results were robust with respect t o changes in assumptions. Even when intentionally biasing the analysis agai nst IM therapy, it was difficult to obtain results that favored PCA. Conclusions: Based upon the institutions and assumptions in this analysis, PCA offers no cost advantages over regular IM therapy in the pain managemen t after hysterectomy. Regular IM injections provided less costly analgesia.