Economic Considerations Related to Providing Adequate Pain Relief for Women in Labour

Abstract

Epidural analgesia and intravenous analgesia with opioids are two techniques for providing pain relief for women in labour. Labour pain is comparable to surgical pain in its severity, and epidural analgesia provides better relief from this pain than intravenous analgesia; a meta-analysis quantified this improvement to be 40 mm on a 100mm pain scale during the first stage of labour. Epidural analgesia also has fewer adverse effects. However, providing epidural analgesia for labour pain costs more. The full cost of providing epidural analgesia can be divided into two components: a baseline-cost component, which captures the costs of hospital care to parturients receiving intravenous analgesia for labour pain; and an incremental-cost component, which estimates the costs arising from incremental care specific to epidural analgesia. The baseline component may be constructed using hospital cost-accounting data pertaining to actual obstetric patients. The incremental component is constructed from a set of recognised complications of epidural and intravenous analgesia, associated incidence rates and estimates of the costs involved, from society's perspective. The incremental expected cost per patient to society of providing epidural analgesia was calculated to be approximately $US338 (1998 values). This cost difference results primarily from increased professional costs (and is particularly sensitive to the method used to estimate the cost of anaesthesia professional services) and increased complication costs associated with epidural analgesia. A rational social policy for providing labour analgesia must weigh the value of improved pain relief from epidural analgesia against the increased cost of epidural analgesia.

Analgesia for labour: a survey of Norwegian practice – with a focus on parenteral opioids

“…Increased epidural costs are due to both the professional resources needed and the increased complication costs. [16][17][18][19] Sufentanil was the most commonly used opioid for EDA, especially in level 2 units. In the larger units (level 1), fentanyl was used as frequently as sufentanil.…”

Remifentanil as analgesia for labour pain

“…Increased epidural costs are due to both the professional resources needed and the increased complication costs, even though the methods for estimating costs have been discussed. 43,52,162,[166][167][168][169] The use of a potent opioid as remifentanil for labour analgesia require close monitoring and one-to-one midwifery, by this increasing the need for resources and personell compared to the use of other systemic opioids. Continuous presence of a competent person during labour (a doula) has been demonstrated to have positive effects on the labour process per see; reducing the need for pharmacological analgesia as EDA, and also reducing the frequency of Caesarean section and instrumentanl delivery, in addition to better coping and less tension for the parturient.…”

Analgesia for Childbirth: Modern Insights Into an Age-Old Challenge and the Quest for an Ideal Approach

“…Although cost awareness among anesthesiologists is poor [89], some fiscal constraint is appropriate in cur rent economic climates. The monetary costs of labor analgesia consist of a baseline component (e.g., the care of the parturient in a hospital setting) and incremental costs specific to the method of analgesia [90,91]. Estimates in the USA in 2002 indicate that the universal provision of epidural analgesia would account for 0.05% of the total health budget, whereas the cost of futile care might exceed 3% [91].…”

“…The monetary costs of labor analgesia consist of a baseline component (e.g., the care of the parturient in a hospital setting) and incremental costs specific to the method of analgesia [90,91]. Estimates in the USA in 2002 indicate that the universal provision of epidural analgesia would account for 0.05% of the total health budget, whereas the cost of futile care might exceed 3% [91]. Women value labor analgesia, but it is difficult to ascribe a monetary value to benefits such as better quality of life, babybonding or earlier provision of childcare responsibilities [90].…”

“…Women value labor analgesia, but it is difficult to ascribe a monetary value to benefits such as better quality of life, babybonding or earlier provision of childcare responsibilities [90]. Epidural analgesia is more costly than opioid analgesia [91,92], but in nullipa rous women it is associated with more instrumen tal deliveries, which are associated with pelvic floor morbidity, creating cost implications and a possible cumulative cost effect [93]. Even after an uncomplicated delivery, epidural analgesia might increase hospital stay and incur higher cost [94].…”