Matsutani Noriyuki, Yamane Hitomi, Suzuki Toshiaki, Murakami Aya, Haga Yuri, Kawamura Masafumi
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Pfizer Japan Inc., Tokyo, Japan.
J Thorac Dis. 2018 Apr;10(4):2321-2330. doi: 10.21037/jtd.2018.03.109.
Our previous randomized controlled trial (RCT) to evaluate the effects of pregabalin on acute post-thoracotomy pain compared with epidural analgesia showed that pregabalin is a safe and effective treatment and that it may be an alternative to epidural analgesia for acute post-thoracotomy pain. In this analysis, to additionally analyze the economic aspects of pregabalin in patients undergoing thoracotomy, we compared the medical costs between pregabalin and epidural analgesia as an analgesic technique for post-thoracotomy pain.
Costs for patients undergoing thoracotomy and receiving either pregabalin or epidural analgesia for post-thoracotomy pain relief in the previous RCT were retrospectively collected from health insurance claims data. The following five cost categories were compared between the groups: (I) surgery costs; (II) costs for surgical materials and medications; (III) costs for anesthetic management; (IV) total hospitalization costs; and (V) costs for outpatient pain-relief medications (from hospital discharge to 6 months after thoracotomy).
We analyzed data from 90 patients (45 patients for each group). Median costs for surgical materials and medications and those for anesthetic management were significantly lower in the pregabalin group than in the epidural analgesia group [(Japanese yen) ¥69,720 ¥77,180, P=0.017; ¥161,000 ¥195,500, P<0.001, respectively]. However, total hospitalization costs and costs for outpatient pain-relief medications were similar between the groups. Pregabalin was prescribed to more patients in the pregabalin group than those in the epidural analgesia group as outpatient treatment (75.0% 37.5%), but median prescribed doses were much smaller in the pregabalin group.
Although the use of pregabalin did not result in lower total hospitalization costs, it may reduce fee-for-service surgery- and anesthesia-related costs. The economic benefits of pregabalin may reinforce its usefulness as an alternative to epidural analgesia, especially for patients who are unsuitable for epidural analgesia.
我们之前进行了一项随机对照试验（RCT），旨在评估普瑞巴林与硬膜外镇痛相比对开胸术后急性疼痛的影响。结果显示，普瑞巴林是一种安全有效的治疗方法，对于开胸术后急性疼痛，它可能是硬膜外镇痛的一种替代方案。在本分析中，为了进一步分析普瑞巴林在开胸手术患者中的经济方面情况，我们比较了普瑞巴林与硬膜外镇痛作为开胸术后疼痛镇痛技术的医疗费用。
从医疗保险理赔数据中回顾性收集之前RCT中接受开胸手术并使用普瑞巴林或硬膜外镇痛缓解开胸术后疼痛的患者的费用。在两组之间比较以下五个费用类别：（I）手术费用；（II）手术材料和药物费用；（III）麻醉管理费用；（IV）总住院费用；以及（V）门诊疼痛缓解药物费用（从出院到开胸术后6个月）。
我们分析了90例患者的数据（每组45例）。普瑞巴林组的手术材料和药物费用以及麻醉管理费用中位数显著低于硬膜外镇痛组[分别为69,720日元对77,180日元，P = 0.017；161,000日元对195,500日元，P < 0.001]。然而，两组之间的总住院费用和门诊疼痛缓解药物费用相似。作为门诊治疗，普瑞巴林组中使用普瑞巴林的患者比硬膜外镇痛组更多（75.0%对37.5%），但普瑞巴林组的处方剂量中位数要小得多。
虽然使用普瑞巴林并未降低总住院费用，但它可能会降低按服务收费的手术和麻醉相关费用。普瑞巴林的经济效益可能会增强其作为硬膜外镇痛替代方案的实用性，特别是对于不适合硬膜外镇痛的患者。
