Analgesia for labor pain: A cost model

Background Epidural analgesia and intravenous analgesia with opioids are tw o techniques for the relief of labor pain. The goal of this study was to de velop a cost-identification model to quantify the costs (from society's per spective) of epidural analgesia compared with intravenous analgesia for lab or pain. Because there is no valid method to assign a dollar value to diffe ring levels of analgesia, the cost of each technique can be compared with t he analgesic benefit (patient pain scores) of each technique. Methods: The authors created a cost model for epidural and intravenous anal gesia by reviewing the literature to determine the rates of associated clin ical outcomes (benefit of each technique to produce analgesia) and complica tions (e.g., postdural puncture headache). The authors then analyzed data f rom their institution's cost-accounting system to determine the hospital co st for parturients admitted for delivery, estimated the cost of each compli cation, and performed a sensitivity analysis to evaluate the cost impact of changing key variables. A secondary analysis was performed assuming that t he cost of nursing was fixed (did not change depending on the number of nur sing interventions). Results: If the cesarean section rate equals 20% for both intravenous and e pidural analgesia, the additional expected cost per patient to society of e pidural analgesia of labor pain ranges from $259 (assuming nursing costs in the labor and delivery suite do not vary with the number of nursing interv entions) to $338 (assuming nursing costs do increase as the number of inter ventions increases) relative to the expected cost of intravenous analgesia for labor pain. This cost difference results from increased professional co sts and complication costs associated with epidural analgesia. Conclusions: Epidural analgesia is more costly than intravenous analgesia. How the cost of the anesthesiologist and nursing care is calculated affects how much more costly epidural analgesia is relative to intravenous analges ia. Published studies have determined that epidural analgesia provides reli ef of labor pain superior to intravenous analgesia, quantified in one study as 40 mm better on a 100-mm scale during the first stage of labor and 29 m m better during the second stage of labor. Patients, physicians, and societ y need to weigh the value of improved pain relief from epidural analgesia v ersus the increased cost of epidural analgesia.