Original contributionA cost-utility and cost-effectiveness analysis of an acute pain service
Introduction
In September 1990, The Royal College of Surgeons of England and the College of Anaesthetists1 suggested that all major hospitals establish an Acute Pain Service (APS). Two main types of APS models have been proposed, i.e., anesthesiologist-based and nurse-based APS.2 An anesthesiologist-based APS organization usually provides “high-tech” pain management services, such as patient-controlled (PCA) or epidural (PCEA) analgesia. This service has considerable impact on pain management in surgical wards, but only a small percentage of patients receive the benefits of APS in this setting.3 In contrast, the nurse-based APS model, as described by Rawal and Berggren2 in 1994, is expected to provide benefit to all surgical patients. Adequate postoperative pain relief is expected as the result of formal organization inside the hospital, less so from the development of new techniques. Low cost has been reported as another advantage of this approach, estimated at $3 to $4 U.S.
Many APS were initiated across the United States and Europe through the 1980s and into the 1990s.4, 5, 6, 7, 8 This action was in response to a pervasive dissatisfaction with the adequacy of postoperative pain management and an apparently substantial extent of undertreatment.9, 10, 11, 12, 13, 14 The theoretical simplicity of managing a single case belies the complexity of the problem as a whole.2 Many of the reasons for poor pain control had been found to relate to the lack of a defined APS.
As APS developed, emphasis was primarily directed to clinical effectiveness, and less attention was given to issues related to the cost-efficient delivery of services.2, 3, 6, 7, 15 In recent decades, however, efforts to contain medical spending have become abundant. Rational decisions as to how best to allocate scarce health care resources require cost-effectiveness data on medical interventions.16, 17, 18, 19, 20 Against this background, the aim of the present study was to perform a cost-effectiveness analysis of acute pain management, with special attention to pain relief, pain-related quality of life, clinical outcomes, and costs associated with the inception of a nurse-based APS in a general teaching hospital. (Note: At the time of our study, 1 EURO = 0.85 US dollars.)
Section snippets
Materials and methods
We conducted the study in a general university teaching hospital of 1005 beds, 240 of which are located on surgical wards.
Results
A total of 1,304 patients with complete data were included in the Pre-APS study period; 671 patients were retained for the Post-APS phase. Patients from the two groups were homogeneous with respect to age and gender. Demographic data and distribution of patients according to type of surgery and anesthesia are shown in Table 2. The distribution of patients according to type of surgery differed significantly between the two phases (p < 0.001). Multiple comparisons revealed that this difference
Discussion
Outcome studies have become an important aspect of health care during the present decade. The potential benefits of any technology can be viewed as an improvement in morbidity and mortality, quality of life, or economics. The challenge to health care professionals from a policy perspective is to implement changes in care in such a way that the individual, as well as society as a whole, benefits.28 There is increasing recognition that inadequate treatment of pain continues to be a clinical
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Cited by (80)
Reconceptualizing Acute Pain Management in the 21st Century
2023, Advances in AnesthesiaEstablishing an Acute Pain Service in Private Practice and Updates on Regional Anesthesia Billing
2018, Anesthesiology ClinicsCitation Excerpt :Groups that are productivity based must factor the opportunity cost of managing acute pain patients instead of billing for surgical anesthesia services. One way to overcome this financial hurdle is hiring advanced practice providers who function under the direction of an anesthesiologist-led APS.30,39,40 Because benefits of RAAPM include cost savings by decreasing LOS in hospital41 and intensive care units,42 as well as lowering patient morbidity4–6 and mortality,7 arguments can be made that hospitals can provide funds for advanced practice providers.
The changing face of acute pain services
2017, Scandinavian Journal of PainCitation Excerpt :The pain treatment instituted by the APS led to reductions in both medical and postoperative pain. Several observational studies have indicated previously that an APS reduces perioperative pain and also the risk of complications although treatment components of the acute pain services varied across the studies [10–12]. Female gender was more represented among the patients seen by the APS team and was also associated with more frequent visits in order to reduce pain.
Acute Pain Management/Regional Anesthesia
2015, Anesthesiology ClinicsCitation Excerpt :When comparing an APS with traditional pain management strategies, it has been shown that an APS is associated with a significant change to patients’ postoperative pain ratings and an increase in satisfaction scores.14 In one study, Stadler and colleagues23 reviewed the cost-effectiveness of a nurse-based APS and showed a significant reduction in pain and reduction in postoperative complications in specific surgical specialties. The cost of the service was 19 Euros per day, resulting in a cost saving of 351 Euros per postoperative pain day averted (a measure of analgesic efficacy reflecting pain as an indicator for quality of life).23
Cost-effectiveness of the Perioperative Pain Management Bundle a registry-based study
2023, Frontiers in Public Health
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Staff Anesthesiologist and Director of the Acute Pain Service, University Hospital Center, Charleroi, Belgium
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Professor of Health Management, University of Applied Sciences, Ludwigshafen, Germany and University of Witten/Herdecke, Witten, Germany
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Biostatistician, University Hospital Center, Charleroi, Belgium
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Professor and Chairman of the Department of Anesthesiology, University Hospital Center, Charleroi, Belgium