Stadler Michaela, Schlander Michael, Braeckman Monique, Nguyen Thanh, Boogaerts Jean G
Department of Anesthesiology, University Hospital Center, Charleroi, Belgium.
J Clin Anesth. 2004 May;16(3):159-67. doi: 10.1016/j.jclinane.2003.06.002.
To analyze, from a societal perspective, the cost-effectiveness and cost-utility of acute pain management after inception of a nurse-based Acute Pain Service (APS) in a general hospital.
Open, observational, interventional study.
Postanesthesia care unit and surgical wards of a university hospital center.
1975 surgical inpatients who had undergone various types of surgery.
Visual analog scale (VAS) pain scores and all systemic analgesics prescribed by anesthesiologists and administered by ward nurses were recorded before and after APS inception. All costs (drugs, disposal, and working time of nurses) related to the APS were identified. Pain measurements were performed by VAS every 4 hours over 3 consecutive days post-surgery and transformed into a health state scale, with 0 being equivalent to absence of pain and 10 to the worst imaginable pain.Using these data, analgesic effectiveness (cost-utility analysis) was expressed as postoperative pain days averted (PPDA) in the two surveys. To perform the cost-effectiveness analysis, we focused on postoperative complications, duration of hospital stay, and postoperative mortality rate. (Note: At the time of the study, 1 EURO = 0.85 US dollars.)
VAS pain scores decreased in the post-APS phase (p < 0.001). One the first day, PPDA was 0.075, on the second day PPDA was 0.05, and the third day PPDA was 0.0375. Cost of analgesic drugs and disposal, as well as nursing hours, increased. The incremental cost of pain management after APS inception amounted to 19 EURO per patient per day, resulting in an incremental cost-effectiveness ratio of 350.77 EURO per PPDA gained. The cost-effectiveness analysis showed minor improvement (reduction of postoperative complication rate in some surgical specialties). Duration of hospital stay and postoperative mortality rate did not change.
A hospital-wide, comprehensive, postoperative pain management program provides an overall positive result for the health care system by improving postoperative pain and morbidity. This service is cost-effective, costing 19 EURO per patient per day. A cost-utility analysis for short-term assessment of quality of life showed no benefit in determining usefulness of such a pain management program.
从社会角度分析综合医院设立以护士为主导的急性疼痛服务（APS）后急性疼痛管理的成本效益和成本效用。
开放性观察性干预研究。
大学医院中心的麻醉后护理单元和外科病房。
1975例接受各种手术的外科住院患者。
记录APS设立前后麻醉医生开具并由病房护士给药的视觉模拟量表（VAS）疼痛评分及所有全身镇痛药。确定与APS相关的所有成本（药物、处置及护士工作时间）。术后连续3天每4小时通过VAS进行疼痛测量，并转化为健康状态量表，0表示无疼痛，10表示可想象到的最严重疼痛。利用这些数据，两次调查中镇痛效果（成本效用分析）表示为避免的术后疼痛天数（PPDA）。为进行成本效益分析，我们重点关注术后并发症、住院时间及术后死亡率。（注：研究时，1欧元 = 0.85美元。）
APS实施阶段VAS疼痛评分降低（p < 0.001）。第一天PPDA为0.075，第二天为0.05，第三天为0.0375。镇痛药及处置成本以及护理时长增加。APS设立后疼痛管理的增量成本为每位患者每天19欧元，导致每获得1个PPDA的增量成本效益比为350.77欧元。成本效益分析显示有轻微改善（部分外科专科术后并发症发生率降低）。住院时间和术后死亡率未改变。
全院范围的综合性术后疼痛管理项目通过改善术后疼痛和发病率为医疗保健系统带来总体积极结果。该服务具有成本效益，每位患者每天成本为19欧元。对生活质量进行短期评估的成本效用分析显示，在此类疼痛管理项目的效用判定方面无益处。
