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. 2023 Sep 7:11:1157484.
doi: 10.3389/fpubh.2023.1157484. eCollection 2023.

Cost-effectiveness of the Perioperative Pain Management Bundle a registry-based study

Suzana Bojic  1   2 , Nebojsa Ladjevic  2   3 , Ivan Palibrk  2   3 , Ivan Soldatovic  2 , Ivana Likic-Ladjevic  2   4 , Winfried Meissner  5 , Ruth Zaslansky  5 , Ulrike M Stamer  6 , Philipp Baumbach  5 , Dusica Stamenkovic  7   8
Affiliations

Cost-effectiveness of the Perioperative Pain Management Bundle a registry-based study

Suzana Bojic et al. Front Public Health. .

Abstract

Introduction: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Bundle; acute postoperative pain; cost-effectiveness; cost-effectiveness plane; economic preference analysis; incremental cost-effectiveness ratio; international pain outcomes questionnaire; pain composite score.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Cost-effectiveness planes with economic preference colors based on the comparison between (A) Phase 1 (before the Bundle implementation) and Phase 2 (after the Bundle implementation) patients, and (B) patients with no Bundle elements and patients with all Bundle elements. Cost increments were plotted on the Y-axis so that more negative values were more favorable. The effectiveness increments were plotted on the X-axis to make the more positive values more favorable. Full lines represent 95% C.I. Results of the economic preference analysis are displayed as colors of the spectrum, with the red end of the spectrum as the least favorable and the green end of the spectrum as the most favorable.
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