Comparative Clinical Effectiveness, Safety, and Cost-Effectiveness of Intravenous Tramadol versus Metamizole for Post-Procedural Pain Management

Background Post-procedural pain is a common complication following biopsy and excision procedures and may negatively impact patient comfort and recovery. At RSUD Jayapura, intravenous tramadol and metamizole are widely used, however, comparative evidence on their clinical effectiveness, safety, and cost-effectiveness remains limited. Methods A prospective cohort study was conducted involving patients aged ≥18 years who received standard analgesic therapy after biopsy or excision. Effectiveness was measured using changes in pain scores (ΔNRS). Adverse events were systematically monitored for 24 h. The economic evaluation included the total treatment cost and cost-effectiveness ratio (CER). Statistical analysis employed the Wilcoxon Signed-Rank Test for within-group ΔNRS and the Mann–Whitney U Test for between-group comparisons. Results Both analgesics significantly reduced pain scores within 24 h. Mean ΔNRS was 3.20 ± 0.76 for tramadol and 3.06 ± 0.69 for metamizole, with no significant difference between groups (p = 0.522). No adverse events were observed. Total treatment cost was lower for tramadol compared to branded metamizole, with CER values of Rp75,271/unit ΔNRS and Rp90,057/unit ΔNRS, respectively. Using generic metamizole reduced total cost to Rp235,108 per patient, but its CER remained higher than tramadol (Rp76,833/unit ΔNRS). Conclusions Both tramadol and metamizole were effective in reducing post-procedural pain and showed no adverse events during the short observation period. Tramadol demonstrated better cost-effectiveness compared to metamizole.