Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis

Sheckter, Clifford C.; Tucker, Austin; Watzker, A.; Ottino, Kevin; Zammert, Martin; Padula, William V.

doi:10.1007/s10549-017-4371-9

Cited by 12 publications

(7 citation statements)

References 20 publications

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“…paracetamol, NSAIDs or COX‐2 selective inhibitors) in a fully implemented multimodal analgesia programme. Not surprisingly, a cost effectiveness study reported higher costs of continuous paravertebral block ; however, these costs would be offset by the reduced duration of hospital stay . Interfascial plane blocks also improve postoperative analgesia with lower pain scores and opioid consumption than general anaesthesia alone.…”

Section: Discussionmentioning

confidence: 99%

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Summary Analgesic protocols used to treat pain after breast surgery vary significantly. The aim of this systematic review was to evaluate the available literature on this topic and develop recommendations for optimal pain management after oncological breast surgery. A systematic review using preferred reporting items for systematic reviews and meta‐analysis guidance with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Seven hundred and forty‐nine studies were found, of which 53 randomised controlled trials and nine meta‐analyses met the inclusion criteria and were included in this review. Quantitative analysis suggests that dexamethasone and gabapentin reduced postoperative pain. The use of paravertebral blocks also reduced postoperative pain scores, analgesia consumption and the incidence of postoperative nausea and vomiting. Intra‐operative opioid requirements were documented to be lower when a pectoral nerves block was performed, which also reduced postoperative pain scores and opioid consumption. We recommend basic analgesics (i.e. paracetamol and non‐steroidal anti‐inflammatory drugs) administered pre‐operatively or intra‐operatively and continued postoperatively. In addition, pre‐operative gabapentin and dexamethasone are also recommended. In major breast surgery, a regional anaesthetic technique such as paravertebral block or pectoral nerves block and/or local anaesthetic wound infiltration may be considered for additional pain relief. Paravertebral block may be continued postoperatively using catheter techniques. Opioids should be reserved as rescue analgesics in the postoperative period. Research is needed to evaluate the role of novel regional analgesic techniques such as erector spinae plane or retrolaminar plane blocks combined with basic analgesics in an enhanced recovery setting.

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Section: Discussionmentioning

confidence: 99%

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…The advantage of using a cost‐utility approach is that there are a range of acceptable values for the incremental cost per QALY gained, termed the incremental cost‐effectiveness ratio, which enables fair comparisons for treatments regardless of the disease or problem it is intended to treat (Shiroiwa et al., ). An alternative approach, which has been used to calculate the cost‐effectiveness of interventions intended to improve outcomes relevant to patient comfort previously, is the willingness to pay method (Offodile et al., ; Pritchard et al., ). Using this method, FAW could be considered cost‐effective for procedures performed with sedation in a cardiac catheterisation laboratory if the extra cost of an incremental gain in thermal comfort is less than the decision maker's willingness to pay for it.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of forced air warming during sedation in the cardiac catheterisation laboratory

Conway

Duff

Sutherland

2018

Journal of Advanced Nursing

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Forced air warming could be considered cost-effective for procedures performed with sedation in a cardiac catheterisation laboratory if the extra cost of an incremental gain in thermal comfort is less than the decision maker's willingness to pay for it. Therefore, those responsible for decision-making regarding use of FAW in the cardiac catheterisation laboratory can use results of our model to decide if it represents good value for their organisation.

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“…The visual analog scale method was used, as this has established success and empirical precedent in the literature. [19][20][21][22][23] Surveys were completed by 14 plastic surgery microsurgery fellows and attending surgeons familiar with the management of these patients. These experts were all presented the same scenarios describing each health state and were asked to provide a utility score from 0 to 100, with 0 corresponding to death and 100 to perfect health (Supplementary Digital Content 1; available online only).…”

Section: Utilitiesmentioning

confidence: 99%

The Cost Utility of Virtual Surgical Planning and Computer-Assisted Design/Computer-Assisted Manufacturing in Mandible Reconstruction Using the Free Fibula Osteocutaneous Flap

Kurlander

Garvey

Largo

et al. 2022

J Reconstr Microsurg

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Background The use of virtual surgical planning and computer-assisted design and computer-assisted manufacturing (CAD/CAM) has become widespread for mandible reconstruction with the free fibula flap. However, the cost utility of this technology remains unknown. Methods The authors used a decision tree model to evaluate the cost utility, from the perspective of a hospital or insurer, of mandible reconstruction using CAD/CAM relative to the conventional (non-CAD/CAM) technique for the free fibula flap. Health state probabilities were obtained from a published meta-analysis. Costs were estimated using 2018 Centers for Medicare and Medicaid Services data. Overall expected cost and quality-adjusted life-years (QALYs) were assessed using a Monte Carlo simulation and sensitivity analyses. Cost effectiveness was defined as an incremental cost utility ratio (ICUR) less than the empirically accepted willingness-to-pay value of $50,000 per QALY. Results Although CAD/CAM reconstruction had a higher expected cost compared with the conventional technique ($36,487 vs. $26,086), the expected QALYs were higher (17.25 vs. 16.93), resulting in an ICUR = $32,503/QALY; therefore, the use of CAD/CAM in free fibula flap mandible reconstruction was cost-effective relative to conventional technique. Monte Carlo sensitivity analysis confirmed CAD/CAM's superior cost utility, demonstrating that it was the preferred and more cost-effective option in the majority of simulations. Sensitivity analyses also illustrated that CAD/CAM remains cost effective at an amount less than $42,903 or flap loss rate less than 4.5%. Conclusion This cost utility analysis suggests that mandible reconstruction with the free fibula osteocutaneous flap using CAD/CAM is more cost effective than the conventional technique.

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Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis

Abstract: Over a broad range of probabilities, PPVB in mastectomy reduces postoperative pain at an acceptable incremental cost compared to GA. Commercial payers should be persuaded to reimburse this technique based on convincing evidence of cost-effectiveness.

Cited by 12 publications

References 20 publications

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

Cost‐effectiveness of forced air warming during sedation in the cardiac catheterisation laboratory

The Cost Utility of Virtual Surgical Planning and Computer-Assisted Design/Computer-Assisted Manufacturing in Mandible Reconstruction Using the Free Fibula Osteocutaneous Flap

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