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Minerva Medica 2016 February;107(1):1-13


language: English

Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy

Andrea FANELLI 1, Matteo RUGGERI 2, Michele BASILE 2, Americo CICCHETTI 2, Flaminia COLUZZI 3, Giorgio DELLA ROCCA 4, Pierangelo DI MARCO 5, Clelia ESPOSITO 6, Guido FANELLI 7, Paolo GROSSI 8, Yigal LEYKIN 9, Ferdinando L. LORINI 10, Adriana PAOLICCHI 11, Marco SCARDINO 12, Antonio CORCIONE 6

1 Department of Medical and Surgical Sciences, Anesthesia and Pain Therapy, S. Orsola-Malpighi Polyclinic, Bologna, Italy; 2 Department of Economics, Sacro Cuore Catholic University, Rome, Italy; 3 Unit of Anesthesia, Intensive Care and Pain Medicine, Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy; 4 Department of Anesthesia and Intensive Care Medicine, University of Udine, Udine, Italy; 5 Unit of Anesthesia and Intensive Care Medicine, Department of Cardiovascular and Respiratory Sciences, Nephrology, Anesthesiology and Geriatrics, Sapienza University of Rome, Rome, Italy; 6 Department of Anesthesia, Resuscitation and Postoperative Intensive Care, Ospedali dei Colli, Naples, Italy; 7 Departments of Anesthesiology and Anesthesia, Intensive Care and Pain Therapy, University Hospital of Parma, Parma, Italy; 8 Department of Locoregional Anesthesia and Pain Therapy, San Donato Polyclinic, University of Milan, Italy; 9 Department of Anesthesiology and Intensive Care, Santa Maria Degli Angeli Hospital, University of Trieste and Udine, Pordenone, Italy; 10 “Papa Giovanni XXIII” Hospital, Bergamo, Italy; 11 Unit of Anesthesia and Pain Therapy, Department of Anesthesia and Intensive Care, Pisa University Hospital, Pisa, Italy; 12 Orthopedic Center, Humanitas Research Hospital, Rozzano, Milan, Italy


BACKGROUND: The aim of this analysis is to evaluate the costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in nine different Italian hospitals, defined as the cumulative cost of drugs, consumable materials and time required for anesthesiologists, surgeons and nurses to administer each analgesic technique.
METHODS: Nine Italian hospitals have been involved in this study through the administration of a questionnaire aimed to acquire information about the Italian clinical practice in terms of analgesia. This study uses activity-based costing (ABC) analysis to identify, measure and give value to the resources required to provide the therapeutic treatment used in Italy to manage the postoperative pain patients face after surgery. A deterministic sensitivity analysis (DSA) has been performed to identify the cost determinants mainly affecting the final cost of each treatment analyzed. Costs have been reclassified according to three surgical macro-areas (abdominal, orthopedic and thoracic) with the aim to recognize the cost associated not only to the analgesic technique adopted but also to the type of surgery the patient faced before undergoing the analgesic pathway.
RESULTS: Fifteen different analgesic techniques have been identified for the treatment of moderate to severe pain in patients who underwent a major abdominal, orthopedic or thoracic surgery. The cheapest treatment actually employed is the oral administration “around the clock” (€ 8.23), whilst the most expensive is continuous peripheral nerve block (€ 223.46). The intravenous patient-controlled analgesia costs € 277.63. In terms of resources absorbed, the non-continuous administration via bolus is the gold standard in terms of cost-related to the drugs used (€ 1.28), and when administered pro re nata it also absorbs the lowest amount of consumables (€0.58€) compared to all other therapies requiring a delivery device. The oral analgesic administration pro re nata is associated to the lowest cost in terms of health professionals involved (€ 6.25), whilst intravenous PCA is the most expensive one (€ 245.66), requiring a massive monitoring on the part of physicians and nurses.
CONCLUSIONS: The analysis successfully collected information about costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in all the nine different Italian hospitals. The interview showed high heterogeneity in the treatment of moderate to severe pain after major abdominal, orthopedic and thoracic surgeries among responding anesthesiologists, with 15 different analgesic modalities reported. The majority of the analgesic techniques considered in the analysis is not recommended by any guideline and their application in real life can be one of the reasons for the high incidence of uncontrolled pain, which is still reported in the postoperative period. Health care costs have become more and more important, although the choice of the best analgesic treatment should be a compromise between efficacy and economic considerations.

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