Is it cost-effective to use a mucosal or paracervical block to relieve thepain and cramping from cryosurgery? A decision model

BACKGROUND. Cryosurgery is an effective treatment for cervical intraepithel ial neoplasia, but it often causes pain and cramping. Both paracervical and mucosal blocks have been shown to provide relief from the pain and crampin g associated with cryosurgery. The purpose of this article is to recommend the use of mucosal block, paracervical block, or no block on the basis of w hich procedure minimizes the costs of averting the pain and cramping that a woman experiences during cryosurgery. METHODS. A decision model was constructed encompassing the options (mucosal block, paracervical block, or no block) that a physician has when performi ng cryosurgery. The 4 possible outcomes for a patient undergoing cryosurger y were diagrammed as: (1) no pain and no cramping; (2) only cramping; (3) o nly pain; and (4) both pain and cramping. Each of these outcomes was measur ed on a 200-mm horizontal visual analog scale. Costs were derived for cryos urgery from the office perspective. Sensitivity analyses were conducted to test the robustness of the analysis. RESULTS. The base case analysis showed that the lowest cost per pain and cr amping averted was for women who had a mucosal block before cryosurgery ($1 53.87), compared with women with a paracervical block ($183.24) and women w ith no block ($218.83). CONCLUSIONS. A mucosal block is the most cost-effective method to avert the pain and cramping from cryosurgery in women who have taken a nonsteroidal anti-inflammatory drug before the procedure.