Analgesia for labor pain: a cost model

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Health Economics

Background:

• Labor pain management commonly involves epidural analgesia and intravenous opioid analgesia.
• A cost-identification model is needed to compare the societal costs of these pain relief methods.
• Comparing costs to analgesic benefits (patient pain scores) is crucial due to the difficulty in assigning monetary value to pain relief.

Purpose of the Study:

• To develop a cost-identification model for comparing epidural analgesia and intravenous analgesia for labor pain from a societal perspective.
• To quantify the economic differences between these two labor pain management techniques.

Main Methods:

• A cost model was constructed using literature review for clinical outcomes and complication rates (e.g., postdural puncture headache).
• Institutional cost-accounting data were analyzed to determine hospital costs for delivery admissions and complication costs.
• Sensitivity analysis was performed to assess the impact of variable changes, including a secondary analysis with fixed nursing costs.

Main Results:

• Epidural analgesia is associated with an additional societal cost of $259 to $338 per patient compared to intravenous analgesia, assuming a 20% cesarean section rate for both.
• This cost disparity is attributed to increased professional fees and complication expenses linked to epidural analgesia.
• The calculation of anesthesiologist and nursing care costs influences the magnitude of the cost difference.

Conclusions:

• Epidural analgesia presents a higher cost to society than intravenous analgesia for labor pain management.
• While epidural analgesia offers superior pain relief, patients, physicians, and society must balance this benefit against the increased financial expenditure.
• The economic impact of epidural analgesia is significantly influenced by how anesthesiologist and nursing care costs are accounted for.