Key result
Patient controlled analgesia in the ED cost an estimated £24.77 (trauma) and £15.17 (abdominal) per hour of moderate or severe pain averted compared to treatment as usual.
Why the study?
Does patient controlled analgesia improve cost-effectiveness compared to treatment as usual in patients admitted from the emergency department with pain?
Does patient controlled analgesia improve cost-effectiveness compared to treatment as usual in patients admitted from the emergency department with pain?
Patient controlled analgesia in the emergency department is associated with an additional cost of approximately £15-£25 per hour of moderate or severe pain averted compared to routine care.
PCA adds ~£20 per 12-hour episode (ICER £15–25 per pain-hour averted); leaves open whether benefits justify routine ED adoption.
Objectives & Background The clinical effectiveness of patient controlled analgesia (PCA) has been demonstrated in a variety of settings. However, PCA is rarely utilized in the emergency department (ED). The aim of this study was to compare the cost effectiveness of PCA versus treatment as usual (TAU) in patients admitted to the ward from the ED with pain due to traumatic injury or non-traumatic abdominal pain. This is the cost-effectiveness analysis of the previously reported PAin SoluTions In the Emergency Setting (PASTIES) study. Methods Pain scores were measured hourly for 12 hours using a visual analogue scale from 0–100 mm. Scores of 45 mm or above reflected moderate or severe pain. Cost-effectiveness is reported as the additional cost per hour in moderate to severe pain avoided by using PCA rather than TAU, the incremental cost-effectiveness ratio (ICER). Sampling variation was estimated using bootstrap methods and the effects of parameter uncertainty explored in a sensitivity analysis. Results For patients suffering pain from traumatic injuries, the cost per hour in moderate or severe pain averted (ICER) was estimated as £24.77 (bootstrap estimate 95% CI=£8.72 to £89.17). The ICER for patients with abdominal pain was estimated as £15.17 (bootstrap estimate 95% CI=£9.03 to £46.00). Overall costs were higher with PCA than TAU in both groups: for pain from traumatic injuries an additional £18.58 (95% CI 15.81 to 21.35) per 12 hours; for abdominal pain £20.18 (95% CI 19.45 to 20.84). Conclusion The cost of PCA use in ED varies with the clinical scenario, but is in the region of £15–£25 per hour of moderate or severe pain averted. Overall additional costs are around £20 per 12-hour patient episode. Figure 1 Sampling variation for traumatic pain trial: ICER estimates from 1,000 bootstrap samples shown on the cost-effectiveness plane Figure 2 Sampling variation for abdominal pain trial: ICER estimates from 1,000 bootstrap samples shown on the cost-effectiveness plane
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Smith et al. (2016) studied Pain due to traumatic injury or non-traumatic abdominal pain. Patient controlled analgesia (PCA) vs. Treatment as usual (TAU) was evaluated on Incremental cost-effectiveness ratio (ICER) per hour in moderate to severe pain avoided. Patient controlled analgesia in the ED cost an estimated £24.77 (trauma) and £15.17 (abdominal) per hour of moderate or severe pain averted compared to treatment as usual.
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