Evaluation of costs and effects of epidural analgesia and patient-controlled intravenous analgesia after major abdominal surgery

Background. The outcome of different treatment strategies forpostoperative pain has been an issue of controversy. Apart fromefficacy and effectiveness a policy decision should also considercost-effectiveness. Since economic analyses on postoperativepain treatment are rare we developed a decision model in a pilotcost-effectiveness analysis (CEA) comparing epidural analgesia(EDA) and patient-controlled intravenous analgesia (PCIA) aftermajor abdominal surgery in routine care. Methods. Using a decision-tree model, treatment with EDA (ropivacaineand morphine) was compared with PCIA (morphine). Effects andcosts of treatment were established. The number of pain-freedays at rest (pain intensity <30 using visual analogue scale1–100 mm) was the primary measure of effect. An incrementalcost-effectiveness ratio (ICER) was calculated as the differencein direct costs divided by the difference in effect. A databaseon 644 patients collected for the purpose of quality controlduring the period of 1997 to 1999 was the main data source.Sensitivity analysis was used to test uncertain data. Results. EDA was more effective in terms of pain-free days butmore expensive. The additional cost for each pain-free day was5652 Euros. Conclusion. It is a judgement of value if the additional costis reasonable. When the cost of around 55 000 Euros per gainedlife-year with full health for other interventions is debated,our result indicates poor cost-effectiveness for EDA. Beforeany conclusion can be drawn concerning policy recommendationsthe difference in costs has to be related to other outcome measuresas length of hospital stay, morbidity and mortality are required.