Costs associated with intravenous patient controlled analgesia (IV-PCA) in us hospitals

Schechter, Leslie N.; Harshaw, Qing; Frye, Carla B.; Ernst, Frank R.; Krukas, Michelle R.; Shillington, Alicia C.

doi:10.1016/j.jval.2013.03.562

Cited by 5 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The addition to the average overall hospitalization costs of intravenous PCA patients due to development of deep venous thrombosis was $18.17, for pulmonary embolism was $43.19, and for postoperative pneumonia was $265.02. 18 …”

Section: Resultsmentioning

confidence: 99%

Cost of opioid intravenous patient-controlled analgesia: results from a hospital database analysis and literature assessment

Palmer

Stephens

2014

CEOR

View full text Add to dashboard Cite

BackgroundIntravenous patient-controlled analgesia (PCA) equipment and opioid cost analyses on specific procedures are lacking. This study estimates the intravenous PCA hospital cost for the first 48 postoperative hours for three inpatient surgeries.MethodsDescriptive analyses using the Premier database (2010–2012) of more than 500 US hospitals were conducted on cost (direct acquisition and indirect cost for the hospital, such as overhead, labor, pharmacy services) of intravenous PCA after total knee/hip arthroplasty (TKA/THA) or open abdominal surgery. Weighted average cost of equipment and opioid drug and the literature-based cost of adverse events and complications were aggregated for total costs.ResultsOf 11,805,513 patients, 272,443 (2.3%), 139,275 (1.2%), and 195,062 (1.7%) had TKA, THA, and abdominal surgery, respectively, with approximately 20% of orthopedic and 29% of abdominal patients having specific intravenous PCA database cost entries. Morphine (57%) and hydromorphone (44%) were the most frequently used PCA drugs, with a mean cost per 30 cc syringe of $16 (30 mg) and $21 (6 mg), respectively. The mean number of syringes used for morphine and hydromorphone in the first 48 hours were 1.9 and 3.2 (TKA), 2.0 and 4.2 (THA), and 2.5 and 3.9 (abdominal surgery), respectively. Average costs of PCA pump, intravenous tubing set, and drug ranged from $46 to $48, from $20 to $22, and from $33 to $46, respectively. Pump, tubing, and saline required to maintain patency of the intravenous PCA catheter over 48 hours ranged from $9 to $13, from $8 to $9, and from $20 to $22, respectively. Supplemental non-PCA opioid use ranged from $56 for THA to $87 for abdominal surgery. Aggregated mean intravenous PCA equipment and opioid cost per patient were $196 (THA), $204 (TKA), and $243 (abdominal surgery). Total costs, including for adverse events, complications, and intravenous PCA errors, ranged from $647 to $694.ConclusionAlthough there is variation between different types of surgery, the hospital cost of intravenous PCA after major surgery is substantial. Novel technology should demonstrate cost-effectiveness in addition to clinical superiority.

show abstract

Section: Resultsmentioning

confidence: 99%

Cost of opioid intravenous patient-controlled analgesia: results from a hospital database analysis and literature assessment

Palmer

Stephens

2014

CEOR

View full text Add to dashboard Cite

show abstract

“…Indirect costs may include the costs of treating IV-related complications, IV PCA pump–related dosing errors, catheter-related infections, adverse events, and needle-stick injuries, as well as the labor associated with nursing care. 5,32…”

Section: Current Costs Associated With IV Pcamentioning

confidence: 99%

“…5,16,17,19 In addition, adverse events resulting from the reduced ambulation associated with IV PCA contributed an average of $18.17 (deep vein thrombosis), $43.19 (pulmonary embolism), and $265.02 (postsurgical pneumonia) in costs. 5,32 These indirect costs are harder to estimate, and it can be difficult to assign causality.…”

Section: Current Costs Associated With IV Pcamentioning

confidence: 99%

“…Indirect costs may include the costs of treating IV-related complications, IV PCA pump-related dosing errors, catheter-related infections, adverse events, and needle-stick injuries, as well as the labor associated with nursing care. 5,32 Hospital costs related to IV PCA following major surgery are thought to be substantial, but little information has been available to date. Results from a recent hospital database analysis and literature search estimated that patients using IV PCA incur an average of $196 to $243 in direct costs.…”

Section: Current Costs Associated With IV Pcamentioning

confidence: 99%

See 1 more Smart Citation

Evolution of Patient-Controlled Analgesia: From Intravenous to Sublingual Treatment

2016

View full text Add to dashboard Cite

Opioid administration delivered intravenously (IV) by patient-controlled analgesia (PCA) devices has been an important development in addressing insufficient management of acute pain in the postsurgical setting. However, IV PCA has several disadvantages, including operator error, risk of patient exposure to analgesic gaps, IV line patency issues, and risk of catheter-related infection, all of which contribute to the total cost of care. Morphine, the most commonly used opioid in IV PCA, has a relatively slow onset of analgesia, which may leave patients with inadequate initial pain control and at risk of opioid dose-stacking. Sufentanil is an opioid with no major active metabolites and a rapid onset of analgesia. The sufentanil sublingual tablet system (SSTS) with a 20-minute lockout and other safety features is a novel noninvasive PCA system in development for on-demand relief of moderate to severe acute pain in the hospital setting. Data from phase 3 trials of the use of SSTS after elective major open abdominal and orthopedic surgery show that analgesia is rapidly achieved, with a longer mean interdosing interval compared with IV PCA morphine (81 vs 47 minutes) and a high level of patient and nurse satisfaction. These data suggest that SSTS may also aid in the avoidance of some of the pitfalls inherent with IV PCA, which may help reduce hospital costs associated with IV PCA–related issues. This article describes the evolution, benefits, issues, and costs associated with IV PCA and reviews data from preclinical studies of sufentanil through SSTS phase 3 trials.

show abstract

Sublingual Sufentanil: A Review in Acute Postoperative Pain

Frampton

2016

Drugs

View full text Add to dashboard Cite

The sufentanil sublingual tablet system (SSTS; Zalviso(®)) is a novel patient-controlled analgesia (PCA) device intended to overcome some of the drawbacks of opioid-based intravenous PCA (IV-PCA). Based on the results of three phase III studies, the SSTS has been approved in the EU for the management of acute moderate to severe postoperative pain in adults in a hospital setting. In a head-to-head comparison with morphine, the gold standard for opioid-based IV-PCA, the SSTS was associated with a more rapid onset of analgesia and higher rates of success, based on patient and healthcare professional global assessments of the method of pain control. Patients and healthcare professionals also rated the SSTS as being easier to use and expressed a greater level of overall satisfaction with this device. The SSTS was generally well tolerated, with an adverse event profile typical of that of other opioids and generally similar to that of placebo. By virtue of its preprogrammed, noninvasive design, the SSTS avoids the risk of pump programming errors and other complications (e.g. infections and analgesic gaps) that can occur with IV-PCA technology; it also imposes less restriction on postoperative mobility. As such, the SSTS provides an effective alternative to opioid-based IV-PCA for the management of acute moderate to severe postoperative pain. Future studies should ideally focus on evaluating the relative cost effectiveness of the SSTS and comparing it with other available needle-free PCA modalities.

show abstract

Costs associated with intravenous patient controlled analgesia (IV-PCA) in us hospitals

Cited by 5 publications

References 0 publications

Cost of opioid intravenous patient-controlled analgesia: results from a hospital database analysis and literature assessment

Cost of opioid intravenous patient-controlled analgesia: results from a hospital database analysis and literature assessment

Evolution of Patient-Controlled Analgesia: From Intravenous to Sublingual Treatment

Sublingual Sufentanil: A Review in Acute Postoperative Pain

Contact Info

Product

Resources

About