Corman Shelby, Shah Nishant, Dagenais Simon
a Pharmerit International , Bethesda , MD , USA.
b Park Ridge Anesthesiology Associates , Midwest Anesthesia Partners , Park Ridge , IL , USA.
J Med Econ. 2018 Jan;21(1):11-18. doi: 10.1080/13696998.2017.1371031. Epub 2017 Sep 18.
To estimate the cost to hospitals of materials (i.e. medications, equipment, and supplies) required to administer common interventions for post-surgical analgesia after total knee arthroplasty (TKA), including single-injection peripheral nerve block (sPNB), continuous peripheral nerve block (cPNB), periarticular infiltration of multi-drug cocktails, continuous epidural analgesia, intravenous patient-controlled analgesia (IV PCA), and local infiltration of bupivacaine liposome injectable suspension (BLIS).
This analysis was conducted using a mixed methods approach combining published literature, publicly available data sources, and administrative data, to first identify the materials required to administer these interventions, and then estimate the cost to the hospital of those materials. Medication costs were estimated primarily using the Wholesale Acquisition Costs (WAC), the cost of reusable equipment was obtained from published sources, and costs for disposable supplies were obtained from the US Government Services Administration (GSA) database. Where uncertainty existed about the technique used when administering these interventions, costs were calculated for multiple scenarios reflecting different assumptions.
The total cost of materials (i.e. medications, equipment, and supplies) required to provide post-surgical analgesia was $41.88 for sPNB with bupivacaine; $756.57 for cFNB with ropivacaine; $16.38 for periarticular infiltration with bupivacaine, morphine, methylprednisolone, and cefuroxime; $453.84 for continuous epidural analgesia with fentanyl and ropivacaine; $178.94 for IV PCA with morphine; and $319.00 for BLIS.
This analysis did not consider the cost of healthcare providers required to administer these interventions. In addition, this analysis focused on the cost of materials and, therefore, did not consider aspects of relative efficacy or safety, or how the choice of intervention for post-surgical analgesia might impact outcomes such as length of stay, re-admissions, discharge status, adverse events, or total hospitalization costs.
This study provided an estimate of the costs to hospitals for materials required to administer commonly used interventions for post-surgical analgesia after TKA.
估算全膝关节置换术（TKA）后进行常见术后镇痛干预措施所需的医院材料成本（即药物、设备和耗材），这些干预措施包括单次注射外周神经阻滞（sPNB）、连续外周神经阻滞（cPNB）、多药鸡尾酒关节周围浸润、连续硬膜外镇痛、静脉自控镇痛（IV PCA）以及布比卡因脂质体注射混悬液（BLIS）局部浸润。
本分析采用混合方法，结合已发表文献、公开可用数据源和管理数据，首先确定实施这些干预措施所需的材料，然后估算医院这些材料的成本。药物成本主要使用批发采购成本（WAC）估算，可重复使用设备的成本从已发表来源获取，一次性耗材的成本从美国政府服务管理局（GSA）数据库获取。当实施这些干预措施所使用的技术存在不确定性时，针对反映不同假设的多种情况计算成本。
提供术后镇痛所需的材料（即药物、设备和耗材）总成本为：布比卡因sPNB为41.88美元；罗哌卡因cFNB为756.57美元；布比卡因、吗啡、甲基强的松龙和头孢呋辛关节周围浸润为16.38美元；芬太尼和罗哌卡因连续硬膜外镇痛为453.84美元；吗啡IV PCA为178.94美元；BLIS为319.00美元。
本分析未考虑实施这些干预措施所需的医疗服务提供者的成本。此外，本分析侧重于材料成本，因此未考虑相对疗效或安全性方面，也未考虑术后镇痛干预措施的选择如何影响住院时间、再入院、出院状态、不良事件或总住院成本等结果。
本研究提供了TKA后进行常用术后镇痛干预措施所需医院材料成本的估算。
