Costing of perioperative intravenous paracetamol and ketorolac therapy in a tertiary Belgian hospital and the economic effect of an adjusted approach in pain therapy

Abstract

Goal of study: Belgium spends 10% of its annual Gross Domestic Product on healthcare expenditure. To economize healthcare, cost-effectiveness analyses gain importance. A recent systematic review found that the perioperative route of paracetamol administration, intravenous vs. oral, did not affect pain or any other postoperative outcome 1. Several studies investigating the analgesic efficacy of different doses of ketorolac in an emergence 2 or perioperative 3 setting failed to demonstrate superiority of a dosing of 30mg over 10mg. In the JESSA hospital, a large tertiary hospital with over 30.000 annual surgical procedures, preoperatively administered intravenous paracetamol and ketorolac 30mg are standard of care in the prevention and treatment of perioperative pain. Our goal was to evaluate the total cost and to calculate the cost reduction of an alternative treatment regimen comprising oral paracetamol and intravenous ketorolac 10mg. Material and Methods: We performed a retrospective observational financial analysis. We reviewed the annual consumption of intravenous paracetamol and ketorolac 10mg at the operating theatre. We also reviewed the total cost price of ketorolac, oral and intravenous paracetamol prescribed for an hospitalized patient in Belgium and subsequently clarified which part are chargeable to the national health insurance, the hospital and the patient. Finally, we calculated the estimated cost reduction in all patients at the operating theatre department and of implementation of this adjusted therapy in half of all other patients admitted to the JESSA hospital. Results: The annual consumption is presented in table 1. The total cost of analgesic drugs is presented in table 2. The estimated cost reduction of the alternative regimen at the operating theatre and the rest of the hospital is 44.914 euro and 75.185 euro, respectively, resulting in a potential cost reduction of 120.099 euro. Conclusion: Implementation of an alternative analgesic treatment regimen would provide a significant cost reduction.