A Cost Analysis of Acute Pain Management After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an extensive operation that can lead to substantial postoperative pain. A continuous wound irrigation system (CWIS) plus intraoperative methadone has been shown to be superior to neuraxial analgesia with an epidural for postoperative pain management. This study investigates the cost of CWIS + methadone compared with epidural analgesia after CRS/HIPEC.

Patient data were extracted from hospital admission data from all patients undergoing open CRS/HIPEC at our institution from 2018 to 2021. Cost data evaluated as hospital charges to the patient were obtained from publicly available hospital charge data. A Markov decision analytic model was developed to compare charge data between two pain management strategies, and a probabilistic sensitivity analysis was conducted using a Monte Carlo simulation.

In our base-case analysis, we found savings of $USD7466 per patient for CWIS + methadone compared with epidural analgesia. In our sensitivity analysis, CWIS + methadone incurred fewer total charges in 93.3% of simulations for an average savings of $USD7844 per patient. The provider charges were lower in 90.4% of simulations, for an average savings of $USD691 per patient. The resource charges were lower in 91.4% of simulations for an average savings of $USD7154 per patient.

This study demonstrates that CWIS + methadone is a more cost-effective strategy in most cases, exhibiting dominance over epidural analgesia in 91.4% of simulations.