Cost of opioid intravenous patient-controlled analgesia: results from a hospital database analysis and literature assessment

Figures & data

Figure 1 Patient attrition flow chart.

Abbreviations: IV, intravenous; THA, total hip arthroplasty; TKA, total knee arthroplasty; PCA, patient-controlled analgesia.

Table 1 Cost per syringe of intravenous PCA opioid drugs (day 0 to 2 from surgery)

Surgery	Morphine, mean ± SD (10th–90th percentile)		Hydromorphone, mean ± SD (10th–90th percentile)
	Cost per syringe, US$	Number of syringes	Cost per syringe, US$	Number of syringes
TKA	$16±12 (6–29)	1.9±1.6 (1–3)	$21±23 (4–38)	3.2±4.2 (1–5)
THA	$15±12 (7–26)	2.0±3.9 (1–3)	$21±23 (3–38)	4.2±9.6 (1–6)
Abdominal surgery	$16±15 (6–28)	2.5±2.1 (1–5)	$20±20 (3–37)	4.0±5.6 (1–8)

Abbreviations: THA, total hip arthroplasty; TKA, total knee arthroplasty; PCA, patient-controlled analgesia; SD, standard deviation.

Table 2 Per patient total cost of equipment and opioid drugs (day 0 to 2 from surgery)

Cost component	Bill standard entry	TKA			THA			Abdominal surgery
		Total cost, US$ (mean)	SD	% (weight)	Total cost, US$ (mean)	SD	% (weight)	Total cost, US$ (mean)	SD	% (weight)
PCA pump	Pump PCA ancillary	$12	2	6.45%	$12	2	6.48%	$21	26	2.79%
	Pump PCA per day	$50	79	81.16%	$49	74	83.09%	$50	86	77.34%
	Pump PCA setup	$50	79	12.38%	$49	76	10.43%	$36	77	19.87%
	Weighted subtotal	$48	–	100%	$47	–	100%	$46	–	100%
PCA IV extension set	Set IV extension PCA	$20	39	42.24%	$24	46	46.57%	$21	50	42.49%
	Set IV PCA anti-siphon	$35	48	7.64%	$21	23	8.74%	$20	37	10.01%
	Set IV PCA anti-siphon extension	$27	9	0.40%	$29	8	0.92%	$17	10	0.17%
	SET IV PCA anti-siphon primary	$36	43	4.95%	$34	41	6.00%	$29	35	9.56%
	Set IV PCA microbore	$15	14	8.21%	$14	13	7.01%	$21	18	3.84%
	Set IV PCA Pump Y	$15	13	36.37%	$17	14	30.59%	$18	24	34.92%
	Set IV Stratofuse PCA	$22	9	1.88%	$19	8	1.53%	$28	10	0.59%
	Weighted subtotal	$20	–	100%	$22	–	100%	$21	–	100%
IV PCA opioid drugs	Morphine	$27	27	57.45%	$25	23	57.51%	$36	41	55.96%
	Hydromorphone	$44	48	42.55%	$44	45	42.49%	$58	67	44.04%
	Weighted subtotal	$35	–	100%	$33	–	100%	$46	–	100%
Non-PCA*	Supplemental opioids	$62	104	2†	$56	100	2†	$86	318	2†
	IV infusion pump	$9	22	1	$9	23	1	$13	28	1
	IV tubing	$8	7	1	$9	8	1	$9	7	1
	Saline (0.9% NaCl 1,000 mL)	$22	26	2	$20	24	2	$22	34	2
Total hospital cost of equipment and opioid drugs‡		$204	–	–	$196	–	–	$243	–	–

Notes:

* Mean total cost values in non-PCA cost items reflect the cost based on assumed number of units (in column “% [weight]”);

† cost reflects the first 48-hour cost of supplemental opioids by doubling the day 1 cost;

‡ total equipment and opioid cost = weighted subtotal (PCA pump) + weighted subtotal (PCA IV extension set) + weighted subtotal (IV PCA opioid drugs) + non-PCA (opioids + pump + tubing + saline).

Abbreviations: IV, intravenous; THA, total hip arthroplasty; TKA, total knee arthroplasty; PCA, patient-controlled analgesia; SD, standard deviation.

Figure 2 Average hospital cost component of IV PCA.

Abbreviations: IV, intravenous; THA, total hip arthroplasty; TKA, total knee arthroplasty; PCA, patient-controlled analgesia.

Table 3 Total average per patient cost of postoperative pain management via intravenous PCA

Drugs, equipment, and adverse events	Estimated cost per patient in US dollars (2012)	Assumption (total cost × incidence or frequency)	Source
Equipment and opioid drug costs	$196–$243	Premier database analysis	Premier
Phlebitis	$2.18	US$24.50 (AUD$28.84*) × 8% = US$1.96 (2008**)	^Citation12, ^Citation13
Bacteremia	$106.76	(US$36,441 + US$24,034)/2 × (0.2% + 0.4%)/2 = 90.71 (2005**)	^Citation12, ^Citation14, ^Citation15
Health care worker needle-stick injury	$1.67	US$3,437 × 36.7/100,000 = 1.26 (2000**)	^Citation16, ^Citation17
IV PCA errors	$35.52	(US$733 × 407 + US$552 × 17.22)/10,000 = US$30.78 (2006**)	^Citation5
Total	$342–$389	–	–

Notes:

* Australian dollars.

** Assumptions for cost show the original base year of cost data reported prior to inflation to 2012 US dollars. Some equations show the weighted average of two prices; others calculate price based on incidence.

Abbreviations: IV, intravenous; PCA, patient-controlled analgesia.

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