Department of Anesthesiology and Intensive Care, University Hospital Medical Centre "Dr. Dragisa Misovic - Dedinje", Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Front Public Health. 2023 Sep 7;11:1157484. doi: 10.3389/fpubh.2023.1157484. eCollection 2023.
The Perioperative Pain Management Bundle was introduced in 10 Serbian PAIN OUT network hospitals to improve the quality of postoperative pain management. The Bundle consists of 4 elements: informing patients about postoperative pain treatment options; administering a full daily dose of 1-2 non-opioid analgesics; administering regional blocks and/or surgical wound infiltration; and assessing pain after surgery. In this study, we aimed to assess the cost-effectiveness of the Bundle during the initial 24 h after surgery.
The assessment of cost-effectiveness was carried out by comparing patients before and after Bundle implementation and by comparing patients who received all Bundle elements to those with no Bundle element. Costs of postoperative pain management included costs of the analgesic medications, costs of labor for administering these medications, and related disposable materials. A multidimensional Pain Composite Score (PCS), the effectiveness measurement, was obtained by averaging variables from the International Pain Outcomes questionnaire evaluating pain intensity, interference of pain with activities and emotions, and side effects of analgesic medications. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental change in costs divided by the incremental change in PCS and plotted on the cost-effectiveness plane along with the economic preference analysis.
The ICER value calculated when comparing patients before and after Bundle implementation was 181.89 RSD (1.55 EUR) with plotted ICERs located in the northeast and southeast quadrants of the cost-effectiveness plane. However, when comparing patients with no Bundle elements and those with all four Bundle elements, the calculated ICER was -800.63 RSD (-6.82 EUR) with plotted ICERs located in the southeast quadrant of the cost-effectiveness plane. ICER values differ across surgical disciplines.
The proposed perioperative pain management Bundle is cost-effective. The cost-effectiveness varies depending on the number of implemented Bundle elements and fluctuates across surgical disciplines.
围手术期疼痛管理包在 10 家塞尔维亚 PAIN OUT 网络医院推出，以提高术后疼痛管理质量。该包由 4 个元素组成：告知患者术后疼痛治疗选择；给予每日 1-2 次全剂量非阿片类镇痛药；给予区域阻滞和/或手术切口浸润；以及术后评估疼痛。在这项研究中，我们旨在评估术后 24 小时内该包的成本效益。
成本效益评估是通过比较实施包前后的患者以及接受所有包元素的患者与没有包元素的患者来进行的。术后疼痛管理的成本包括镇痛药的成本、给予这些药物的劳动力成本以及相关的一次性材料成本。多维疼痛综合评分（PCS）是通过平均国际疼痛结局问卷中评估疼痛强度、疼痛对活动和情绪的干扰以及镇痛药副作用的变量来获得的。增量成本效益比（ICER）是通过将成本的增量变化除以 PCS 的增量变化计算得出的，并与经济偏好分析一起绘制在成本效益平面上。
当比较实施包前后的患者时，计算出的 ICER 值为 181.89 塞尔维亚第纳尔（1.55 欧元），绘制的 ICER 位于成本效益平面的东北和东南象限。然而，当比较没有包元素的患者和有所有四个包元素的患者时，计算出的 ICER 为-800.63 塞尔维亚第纳尔（-6.82 欧元），绘制的 ICER 位于成本效益平面的东南象限。ICER 值因手术学科而异。
拟议的围手术期疼痛管理包具有成本效益。成本效益取决于实施的包元素数量，并在手术学科之间波动。
