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Related Experiment Videos

Cost considerations in patient-controlled analgesia.

A Jacox1, D B Carr, D M Mahrenholz

  • 1Wayne State University, College of Nursing, Detroit, Michigan, USA.

Pharmacoeconomics
|July 6, 1997
PubMed
Summary

Patient-controlled analgesia (PCA) offers better pain relief but at a higher cost than traditional methods. More research is needed to determine the true cost-effectiveness of PCA for diverse patient groups and settings.

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Area of Science:

  • Pain Management
  • Health Economics
  • Pharmacology

Background:

  • Patient-controlled analgesia (PCA) involves patients self-administering small doses of analgesics via infusion pumps for prompt pain relief without over-sedation.
  • PCA use is increasing in both hospital and home settings due to patient satisfaction and comparable or superior analgesia.
  • This review focuses on cost aspects of PCA, analyzing studies published between 1984 and 1995.

Purpose of the Study:

  • To review and analyze the cost considerations of patient-controlled analgesia (PCA) based on existing literature.
  • To identify gaps and limitations in the research regarding the economic evaluation of PCA.

Main Methods:

  • Literature review of studies published between January 1984 and December 1995 focusing on the cost of PCA.

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  • Comparison of direct costs (drug, equipment, labor) and indirect costs (length of stay, adverse effects) of PCA versus conventional methods like intramuscular injections.
  • Analysis of study designs, including case reports, descriptive studies, quasi-experimental studies, and randomized controlled trials.

    • Main Results:

    • Research on PCA costs is dominated by lower-quality studies; only six randomized controlled trials were identified, all in postoperative patients.
    • Most studies compared direct costs, with few including indirect costs.
    • Findings on PCA's cost-effectiveness are mixed: some studies show superior analgesia at higher costs, while one reported higher costs with less pain relief compared to intramuscular therapy.

    Conclusions:

    • The cost-effectiveness of PCA for pain management remains unresolved due to methodological variations, diverse settings, patient populations, and evolving technology.
    • Substantial variations in drug and device costs complicate cross-study comparisons.
    • There is a critical need for rigorous cost-effectiveness, cost-utility, and cost-benefit analyses to guide appropriate clinical and economic use of PCA.