Objectives: To assess the economics of patient-controlled
analgesia (PCA) treatment versus regular intramuscular (IM) injections of
opioid analgesia for pain management after hysterectomy.
Methods: Cost-minimization analysis was used based on the
comparable pain control results achieved in the two treatment groups.
Observations were taken of treatment-related events with personnel (mostly
nursing) time implications during the trial. Times were then associated with
these events in an independent 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 all 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 pump being included in the analyses. These results were robust
with respect to changes in assumptions. Even when intentionally biasing the
analysis against 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
management after hysterectomy. Regular IM injections provided less costly
analgesia.
