Transcript Duramorph … Worth the cost? - Texas Tech University Health

Duramorph –A Cost Analysis
Scott Frankfather, M.D. PGY IV
Robert Casanova, M.D.
Texas Tech Physicians
Department of Obstetrics and Gynecology
March 6, 2009
Duramorph—A Cost Analysis
• Objective: To evaluate the cost
effectiveness of intrathecal morphine
during spinal anesthesia for cesarean
section.
Duramorph—A Cost Analysis
• Background: Cesarean section is the
most commonly performed surgery in
the United States. 26% of all deliveries
in 2002.
– Anesthesia includes
» Epidural
» Spinal
» General
» Local
Duramorph—A Cost Analysis
• Background:
– The most common types of anesthesia:
» epidural or spinal anesthesia.
– The addition of morphine to the intrathecal (spinal)
anesthesia is becoming a more common practice
» pain relief for up to twenty-four hours
» Negates need for patient controlled analgesia
(PCA)
– Patients require additional medications
» Oral narcotics
» Intravenous or intramuscular narcotics
» Antihistamines
» Antiemetics
Duramorph—A Cost Analysis
• Background:
– A review of literature in PubMed found no
study evaluating the cost-effectiveness of
intrathecal morphine.
Duramorph—A Cost Analysis
• Study Design:
– Retrospective chart review comparing
medication costs of patients receiving
intrathecal morphine anesthesia and
matched controls of patients receiving
spinal anesthesia with PCA between
January 1, 2008 and December 31, 2008
at University Medical Center.
Duramorph—A Cost Analysis
– Hypothesis: Intrathecal morphine
provides adequate pain relief but is not
cost effective when considering all
additional medications required by the
patient.
Duramorph—A Cost Analysis
• Materials and Methods:
– The patients were identified using the
Premier software with the assistance of
the office of Performance Improvement at
University Medical Center in Lubbock,
Texas.
– The costs of all anesthesia related
medications following a cesarean section
were analyzed.
Duramorph—A Cost Analysis
• Materials and Methods:
– After identifying patients of interest and obtaining
the total cost of medications of interest, all patient
identifiers were removed from the data.
– Data collected included:
•
•
•
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Gravidity
Parity
Weight
Type of
anesthesia
• Skin incision
• Cost of all pain
medication
• Cost of medication
resulting from
administration of
anesthesia.
Duramorph—A Cost Analysis
• Materials and Methods:
– Population: 617 patients who underwent a
cesarean section between January 1,
2008 and December 31, 2008.
– Subdivided into groups according to type
of anesthesia
• Duramorph Group: 54 Patients
• PCA Group: 104 Patients were selected
randomly from 517 who received spinal with
PCA
Duramorph—A Cost Analysis
• Materials and Methods:
– Exclusion criteria:
• Hospital stays longer than 7 days
– n=3 from Duramorph group
– n=32 from PCA group
• Incomplete medical records (n=2)
• Duplicated anesthesia charges (n=18)
• No anesthesia charges (n=28)
Results
Type of
Anesthesia
Number
Of
Patients
Individual
Cost
Additional
Costs
Total
Cost
Duramorph
54
$3.93
$14.43
$18.14
PCA
517
$18.76
$15.50
$33.76
Total
C-sections
617
Results
Duramorph
PCA
Age
28.76
24.69
Weight
91.00
90.48
Gravidity
2.74
2.27
Parity
1.32
0.93
Cesarean #
1.91
1.58
Results
Total Cost
Duramorph
PCA
$16.92
$24.20
Individual Cost $3.76
$18.10
Other Costs
$13.38
$16.10
Total Charges
$3552.11
$3888.43
Length of Stay 3.16 days
3.55 days
Average costs of medications excluding the cost of PCA pump
Conclusion
• Intrathecal morphine provides adequate
pain relief and is cost effective when
considering all additional medications
required by the patient. A direct
comparison of the mean medication
cost reveals a statistically significant yet
small savings; however, the amount
saved by using Duramorph spinal is
$336.32 per patient when considering
all charges to the patient.
References
• Cunningham, Leveno, et al. Willimas
Obstetrics. 22nd ed. New York:
McGraw-Hill, 2005. 473-490, 588-590.
• Gabbe, Niebyl, et al.,eds. Obstetrics:
Normal and Problem Pregnancies. 4th
ed. Philadelphia: Churchill Livingston,
2002. 539-543, 458-465
Thank You
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Dr. Casanova
Dr. Prien
Karen Lemons
Shane Terrell
Todd Jackson, RPh.