Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy

Andrea Fanelli, Matteo Ruggeri, Michele Basile, Americo Cicchetti, Flaminia Coluzzi, Giorgio Della R Occa, Pierangelo Di Marco, Clelia Esposito, Guido Fanelli, Paolo Grossi, Yigal Leykin, F. Luca Lorini, Adriana Paolicchi, Marco Scardino, Antonio C. Orcione

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The aim of this analysis is to evaluate the costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in nine different Italian hospitals, defined as the cumulative cost of drugs, consumable materials and time required for anesthesiologists, surgeons and nurses to administer each analgesic technique. METHODS: Nine Italian hospitals have been involved in this study through the administration of a questionnaire aimed to acquire information about the Italian clinical practice in terms of analgesia. This study uses activity-based costing (ABC) analysis to identify, measure and give value to the resources required to provide the therapeutic treatment used in Italy to manage the postoperative pain patients face after surgery. A deterministic sensitivity analysis (DSA) has been performed to identify the cost determinants mainly affecting the final cost of each treatment analyzed. Costs have been reclassified according to three surgical macro-areas (abdominal, orthopedic and thoracic) with the aim to recognize the cost associated not only to the analgesic technique adopted but also to the type of surgery the patient faced before undergoing the analgesic pathway. RESULTS: Fifteen different analgesic techniques have been identified for the treatment of moderate to severe pain in patients who underwent a major abdominal, orthopedic or thoracic surgery. The cheapest treatment actually employed is the oral administration "around the clock" (€ 8.23), whilst the most expensive is continuous peripheral nerve block (€ 223.46). The intravenous patient-controlled analgesia costs € 277.63. In terms of resources absorbed, the non-continuous administration via bolus is the gold standard in terms of cost-related to the drugs used (€ 1.28), and when administered pro re nata it also absorbs the lowest amount of consumables (€0.58€) compared to all other therapies requiring a delivery device. The oral analgesic administration pro re nata is associated to the lowest cost in terms of health professionals involved (€ 6.25), whilst intravenous PCA is the most expensive one (€ 245.66), requiring a massive monitoring on the part of physicians and nurses. CONCLUSIONS: The analysis successfully collected information about costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in all the nine different Italian hospitals. The interview showed high heterogeneity in the treatment of moderate to severe pain after major abdominal, orthopedic and thoracic surgeries among responding anesthesiologists, with 15 different analgesic modalities reported. The majority of the analgesic techniques considered in the analysis is not recommended by any guideline and their application in real life can be one of the reasons for the high incidence of uncontrolled pain, which is still reported in the postoperative period. Health care costs have become more and more important, although the choice of the best analgesic treatment should be a compromise between efficacy and economic considerations.

Original languageEnglish
Pages (from-to)1-13
Number of pages13
JournalMinerva Medica
Volume107
Issue number1
Publication statusPublished - Feb 1 2016

Fingerprint

Pain Management
Postoperative Pain
Italy
Analgesics
Costs and Cost Analysis
Orthopedic Procedures
Orthopedics
Thorax
Therapeutics
Pain
Health Care Costs
Thoracic Surgery
Oral Administration
Nurses
Patient-Controlled Analgesia
Passive Cutaneous Anaphylaxis
Drug Costs
Nerve Block
Peripheral Nerves
Postoperative Period

Keywords

  • Analgesia
  • Health care costs
  • Patient-controlled analgesia
  • Physicians' practice patterns
  • Postoperative pain

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Fanelli, A., Ruggeri, M., Basile, M., Cicchetti, A., Coluzzi, F., Occa, G. D. R., ... Orcione, A. C. (2016). Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy. Minerva Medica, 107(1), 1-13.

Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy. / Fanelli, Andrea; Ruggeri, Matteo; Basile, Michele; Cicchetti, Americo; Coluzzi, Flaminia; Occa, Giorgio Della R; Di Marco, Pierangelo; Esposito, Clelia; Fanelli, Guido; Grossi, Paolo; Leykin, Yigal; Lorini, F. Luca; Paolicchi, Adriana; Scardino, Marco; Orcione, Antonio C.

In: Minerva Medica, Vol. 107, No. 1, 01.02.2016, p. 1-13.

Research output: Contribution to journalArticle

Fanelli, A, Ruggeri, M, Basile, M, Cicchetti, A, Coluzzi, F, Occa, GDR, Di Marco, P, Esposito, C, Fanelli, G, Grossi, P, Leykin, Y, Lorini, FL, Paolicchi, A, Scardino, M & Orcione, AC 2016, 'Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy', Minerva Medica, vol. 107, no. 1, pp. 1-13.
Fanelli A, Ruggeri M, Basile M, Cicchetti A, Coluzzi F, Occa GDR et al. Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy. Minerva Medica. 2016 Feb 1;107(1):1-13.
Fanelli, Andrea ; Ruggeri, Matteo ; Basile, Michele ; Cicchetti, Americo ; Coluzzi, Flaminia ; Occa, Giorgio Della R ; Di Marco, Pierangelo ; Esposito, Clelia ; Fanelli, Guido ; Grossi, Paolo ; Leykin, Yigal ; Lorini, F. Luca ; Paolicchi, Adriana ; Scardino, Marco ; Orcione, Antonio C. / Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy. In: Minerva Medica. 2016 ; Vol. 107, No. 1. pp. 1-13.
@article{6054c05d8afd4c808d106a21fa72c6bf,
title = "Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy",
abstract = "BACKGROUND: The aim of this analysis is to evaluate the costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in nine different Italian hospitals, defined as the cumulative cost of drugs, consumable materials and time required for anesthesiologists, surgeons and nurses to administer each analgesic technique. METHODS: Nine Italian hospitals have been involved in this study through the administration of a questionnaire aimed to acquire information about the Italian clinical practice in terms of analgesia. This study uses activity-based costing (ABC) analysis to identify, measure and give value to the resources required to provide the therapeutic treatment used in Italy to manage the postoperative pain patients face after surgery. A deterministic sensitivity analysis (DSA) has been performed to identify the cost determinants mainly affecting the final cost of each treatment analyzed. Costs have been reclassified according to three surgical macro-areas (abdominal, orthopedic and thoracic) with the aim to recognize the cost associated not only to the analgesic technique adopted but also to the type of surgery the patient faced before undergoing the analgesic pathway. RESULTS: Fifteen different analgesic techniques have been identified for the treatment of moderate to severe pain in patients who underwent a major abdominal, orthopedic or thoracic surgery. The cheapest treatment actually employed is the oral administration {"}around the clock{"} (€ 8.23), whilst the most expensive is continuous peripheral nerve block (€ 223.46). The intravenous patient-controlled analgesia costs € 277.63. In terms of resources absorbed, the non-continuous administration via bolus is the gold standard in terms of cost-related to the drugs used (€ 1.28), and when administered pro re nata it also absorbs the lowest amount of consumables (€0.58€) compared to all other therapies requiring a delivery device. The oral analgesic administration pro re nata is associated to the lowest cost in terms of health professionals involved (€ 6.25), whilst intravenous PCA is the most expensive one (€ 245.66), requiring a massive monitoring on the part of physicians and nurses. CONCLUSIONS: The analysis successfully collected information about costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in all the nine different Italian hospitals. The interview showed high heterogeneity in the treatment of moderate to severe pain after major abdominal, orthopedic and thoracic surgeries among responding anesthesiologists, with 15 different analgesic modalities reported. The majority of the analgesic techniques considered in the analysis is not recommended by any guideline and their application in real life can be one of the reasons for the high incidence of uncontrolled pain, which is still reported in the postoperative period. Health care costs have become more and more important, although the choice of the best analgesic treatment should be a compromise between efficacy and economic considerations.",
keywords = "Analgesia, Health care costs, Patient-controlled analgesia, Physicians' practice patterns, Postoperative pain",
author = "Andrea Fanelli and Matteo Ruggeri and Michele Basile and Americo Cicchetti and Flaminia Coluzzi and Occa, {Giorgio Della R} and {Di Marco}, Pierangelo and Clelia Esposito and Guido Fanelli and Paolo Grossi and Yigal Leykin and Lorini, {F. Luca} and Adriana Paolicchi and Marco Scardino and Orcione, {Antonio C.}",
year = "2016",
month = "2",
day = "1",
language = "English",
volume = "107",
pages = "1--13",
journal = "Minerva Medicolegale e Archivio di Antropologia Criminale",
issn = "0026-4806",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "1",

}

TY - JOUR

T1 - Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy

AU - Fanelli, Andrea

AU - Ruggeri, Matteo

AU - Basile, Michele

AU - Cicchetti, Americo

AU - Coluzzi, Flaminia

AU - Occa, Giorgio Della R

AU - Di Marco, Pierangelo

AU - Esposito, Clelia

AU - Fanelli, Guido

AU - Grossi, Paolo

AU - Leykin, Yigal

AU - Lorini, F. Luca

AU - Paolicchi, Adriana

AU - Scardino, Marco

AU - Orcione, Antonio C.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - BACKGROUND: The aim of this analysis is to evaluate the costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in nine different Italian hospitals, defined as the cumulative cost of drugs, consumable materials and time required for anesthesiologists, surgeons and nurses to administer each analgesic technique. METHODS: Nine Italian hospitals have been involved in this study through the administration of a questionnaire aimed to acquire information about the Italian clinical practice in terms of analgesia. This study uses activity-based costing (ABC) analysis to identify, measure and give value to the resources required to provide the therapeutic treatment used in Italy to manage the postoperative pain patients face after surgery. A deterministic sensitivity analysis (DSA) has been performed to identify the cost determinants mainly affecting the final cost of each treatment analyzed. Costs have been reclassified according to three surgical macro-areas (abdominal, orthopedic and thoracic) with the aim to recognize the cost associated not only to the analgesic technique adopted but also to the type of surgery the patient faced before undergoing the analgesic pathway. RESULTS: Fifteen different analgesic techniques have been identified for the treatment of moderate to severe pain in patients who underwent a major abdominal, orthopedic or thoracic surgery. The cheapest treatment actually employed is the oral administration "around the clock" (€ 8.23), whilst the most expensive is continuous peripheral nerve block (€ 223.46). The intravenous patient-controlled analgesia costs € 277.63. In terms of resources absorbed, the non-continuous administration via bolus is the gold standard in terms of cost-related to the drugs used (€ 1.28), and when administered pro re nata it also absorbs the lowest amount of consumables (€0.58€) compared to all other therapies requiring a delivery device. The oral analgesic administration pro re nata is associated to the lowest cost in terms of health professionals involved (€ 6.25), whilst intravenous PCA is the most expensive one (€ 245.66), requiring a massive monitoring on the part of physicians and nurses. CONCLUSIONS: The analysis successfully collected information about costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in all the nine different Italian hospitals. The interview showed high heterogeneity in the treatment of moderate to severe pain after major abdominal, orthopedic and thoracic surgeries among responding anesthesiologists, with 15 different analgesic modalities reported. The majority of the analgesic techniques considered in the analysis is not recommended by any guideline and their application in real life can be one of the reasons for the high incidence of uncontrolled pain, which is still reported in the postoperative period. Health care costs have become more and more important, although the choice of the best analgesic treatment should be a compromise between efficacy and economic considerations.

AB - BACKGROUND: The aim of this analysis is to evaluate the costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in nine different Italian hospitals, defined as the cumulative cost of drugs, consumable materials and time required for anesthesiologists, surgeons and nurses to administer each analgesic technique. METHODS: Nine Italian hospitals have been involved in this study through the administration of a questionnaire aimed to acquire information about the Italian clinical practice in terms of analgesia. This study uses activity-based costing (ABC) analysis to identify, measure and give value to the resources required to provide the therapeutic treatment used in Italy to manage the postoperative pain patients face after surgery. A deterministic sensitivity analysis (DSA) has been performed to identify the cost determinants mainly affecting the final cost of each treatment analyzed. Costs have been reclassified according to three surgical macro-areas (abdominal, orthopedic and thoracic) with the aim to recognize the cost associated not only to the analgesic technique adopted but also to the type of surgery the patient faced before undergoing the analgesic pathway. RESULTS: Fifteen different analgesic techniques have been identified for the treatment of moderate to severe pain in patients who underwent a major abdominal, orthopedic or thoracic surgery. The cheapest treatment actually employed is the oral administration "around the clock" (€ 8.23), whilst the most expensive is continuous peripheral nerve block (€ 223.46). The intravenous patient-controlled analgesia costs € 277.63. In terms of resources absorbed, the non-continuous administration via bolus is the gold standard in terms of cost-related to the drugs used (€ 1.28), and when administered pro re nata it also absorbs the lowest amount of consumables (€0.58€) compared to all other therapies requiring a delivery device. The oral analgesic administration pro re nata is associated to the lowest cost in terms of health professionals involved (€ 6.25), whilst intravenous PCA is the most expensive one (€ 245.66), requiring a massive monitoring on the part of physicians and nurses. CONCLUSIONS: The analysis successfully collected information about costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in all the nine different Italian hospitals. The interview showed high heterogeneity in the treatment of moderate to severe pain after major abdominal, orthopedic and thoracic surgeries among responding anesthesiologists, with 15 different analgesic modalities reported. The majority of the analgesic techniques considered in the analysis is not recommended by any guideline and their application in real life can be one of the reasons for the high incidence of uncontrolled pain, which is still reported in the postoperative period. Health care costs have become more and more important, although the choice of the best analgesic treatment should be a compromise between efficacy and economic considerations.

KW - Analgesia

KW - Health care costs

KW - Patient-controlled analgesia

KW - Physicians' practice patterns

KW - Postoperative pain

UR - http://www.scopus.com/inward/record.url?scp=84961999200&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961999200&partnerID=8YFLogxK

M3 - Article

C2 - 26999384

AN - SCOPUS:84961999200

VL - 107

SP - 1

EP - 13

JO - Minerva Medicolegale e Archivio di Antropologia Criminale

JF - Minerva Medicolegale e Archivio di Antropologia Criminale

SN - 0026-4806

IS - 1

ER -