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PCP7: COSTS AND OUTCOMES OF REGIONAL VERSUS GENERAL VERSUS COMBINATION ANESTHESIA AND ANALGESIA TECHNIQUES IN GREEK PATIENTS UNDERGOING HIP ARTHROPLASTY
207
Abstracts tion in relation to subsequent statements, therefore appropriate clarifications had to be added. The response scale “very completely, completely, average, incompletely, very incompletely” was impossible to translate literally. The following equidistant responses were substituted: “completely, quite a bit, average, a little bit, not at all.” CONCLUSIONS: A rigorous translation methodology was performed to ensure conceptual equivalence and acceptability of translations. International feedback obtained through the translation process revealed issues regarding the original instrument, indicating that future amendments to the original may be necessary. Psychometric testing will be conducted to ensure reliability and validity of each translation, appropriateness of the questionnaire in each country, and comparability of data across countries.
PCP5
USE OF OPIOID ANALGESICS FOR NONMALIGNANT PAIN CONDITIONS: A CROSS-SECTIONAL CHARACTERIZATION Sesti AM, Dodd SL, Rai RB, Wilson J Janssen Research Foundation, Titusville, NJ, USA OBJECTIVE: The purpose of this study was to evaluate prescribing of opioid analgesics for the treatment of nonmalignant pain conditions. METHODS: The 1995 MarketScan® database was used to identify patients without malignant diagnoses and at least one prescription for an opioid. The resulting cohort was classified into three mutually exclusive categories: transdermal fentanyl (TDF, n 118), long-acting opioids (LA, n 136), and short-acting opioids (SA, n 92,412). Demographics, diagnosis categories, and resource utilization (outpatient, inpatient, and prescription claims) were examined. RESULTS: The number of patients in the SA group was disproportionately larger than the other groups preventing a direct comparison. Their average age was 40 years, primarily female, and 71% working full time. The most common diagnosis category was musculoskeletal (MSK) and lumbago was the most frequent condition. For comparative purposes, we examined diagnoses groups and resource utilization for the TDF and LA groups. Age, gender, and employment status was similar for both groups. The MSK category and lumbago diagnoses were also the most common conditions. TDF patients had more lumbago physician visits but less cost/patient compared to the LA group (median 6 visits, $49.50 versus 2.5 visits, $74.50, respectively). Inpatient use was similar between groups with a median of two occurrences/patient. The median prescription use/patient of TDF was slightly less than LA (3 versus 4.5) and both groups used a similar number of other opioid analgesics (median 13). CONCLUSION: This study suggests a similar distribution of conditions associated with the use of TDF, LA, and SA opioids. However, SA opioid utilization in nonmalignant pain differs from TDF and LA agents. Further
analysis is necessary to identify characteristics that differentiate these groups.
PCP6
OPIOID ANALGESICS USE IN PATIENTS WITH NONMALIGNANT PAIN: SELECTING AN APPROPRIATE COMPARISON GROUP Loughlin JE1, Walker AM1, Cole JA1, Wilson J2, Dodd SL2, Sesti A-M2 1 Epidemiology Resources Inc., Newton, MA, USA; 2Janssen Research Foundation, Titusville, NJ, USA OBJECTIVE: The purpose of the study is to compare the resource utilization and costs related to the total medical care of Duragesic patients with those incurred by patients who have been prescribed long-acting opioids. This abstract focuses on the methodology utilized to select a comparison group for the Duragesic patients. METHODS: We identified all patients without cancer in a New England insurer database with at least one prescription for Duragesic from January 1, 1995 through December 31, 1997. We required each patient to be enrolled 30 days prior to the prescription index date and the ensuing 90 days, and to have drug benefits (n 420). We similarly identified patients with at least one prescription for a long-acting opioid (n 1239). We characterized the patients by age, gender, health services utilized, costs incurred, diagnosis, and drugs dispensed in the 30 days prior the index date. RESULTS: Duragesic and long-acting opioid patients had similar distributions of age, sex, and inpatient and outpatient diagnoses. For both groups, musculoskeletal/ connective tissue conditions were among the most frequent diagnoses, and costs were highest in the month preceding the first opioid dispensing, dropping by about 50% over the ensuing 90 days. CONCLUSIONS: Patterns of health resource utilization and cost are similar for the two groups. Total costs incurred are highest in the 30 days prior to the initial dispensing and drop considerably during the following 90 days. There is overlap among the non-malignant conditions treated with Duragesic and long-acting opioids. These results suggest that it may be possible to identify a useful and appropriate comparison group for the Duragesic patients.
PCP7
COSTS AND OUTCOMES OF REGIONAL VERSUS GENERAL VERSUS COMBINATION ANESTHESIA AND ANALGESIA TECHNIQUES IN GREEK PATIENTS UNDERGOING HIP ARTHROPLASTY Yfantopoulos Y1, Athanasiadis H2, Karokis A3, Tsekouras V3, Yourgioti G3, Pierrakos G1, Karamihali E4, Hantziandreou E5 1 University of Athens, Athens, Greece, 2Hellenic Airforce Hospital, Athens, Greece, 3Astra Hellas, Athens, Greece, 4 Evangelismos Hospital, Athens, Greece, 5ASTRA A.B, Athens, Greece
208
Abstracts
OBJECTIVE: To compare the costs and effectiveness of general (GA) versus regional (RA) versus combination (general/epidural) (GEA) of anesthetic/analgesic techniques in patients undergoing hip arthroplasty. METHOD: In a prospective cohort open label multicenter study in three major general hospitals in Athens, all 210 patients undergoing hip arthroplasty during a period of one calendar year ending December 25, 1998 were studied. Patients were eligible for all anesthesia techniques. Doctors followed their current anesthesia/analgesia technique. Total costs included all pre-, intra-, and postoperative direct medical costs (health system perspective). Resource use was recorded and per hospital unit prices were transformed to US dollars. Effectiveness was measured by classifying patients in four intervals of pain intensity along a linear Visual Analogue Scale (0–30VAS “excellent” analgesia, 31–50VAS “good” analgesia, 51–70VAS “bad” analgesia, and 71–100VAS “insufficient” analgesia). Separate cost and effectiveness analyses were performed and a stochastic cost-effectiveness analysis model is being used to calculate incremental cost-effectiveness ratios. RESULTS: Significant total-costs differences exist amongst anesthetic/analgesic techniques (p 0.001). GA presented higher operative costs than RA, whereas GEA presented the highest postoperative costs. GEA showed clinically and statistically significant lower pain scores at recovery room and during the 4 postoperative days (p 0.001). Preliminary results indicate that a moderate increase in costs through applying continuous postoperative epidural analgesia (CEPA) is associated with better pain relief indicated by lower numbers of patients in “bad” and “insufficient” analgesia levels. CONCLUSIONS: Despite a moderate postoperative cost increase, epidural anesthesia/analgesia and GEA result in clinically significant improvements in patients’ pain relief during the study period. Postoperative pain management practices are key factors influencing the direction and magnitude of costs and effects of the various anesthesia/ analgesia techniques.
PCP8
ASSESSMENT OF SURGICAL ANESTHESIA AND POSTOPERATIVE ANALGESIA USING A PAIN VISUAL ANALOG SCALE Yfantopoulos Y1, Athanasiadis A2, Karokis A3, Tsekouras V3, Yourgioti G3, Pierrakos G1, Pagouni H4, Hantziandreou E5 1 University of Athens, Athens, Greece, 2Hellenic Airforce Hospital, Athens, Greece, 3Astra Hellas, Athens, Greece, 4 Nikea General Hospital, Athens, Greece, 5ASTRA A.B, Athens, Greece OBJECTIVE: To compare the effectiveness of general (GA) versus epidural (EA) versus spinal (SA) versus a combination (GEA) anesthetic technique in terms of pain relief for patients undergoing hip arthroplasty. METHOD: In a prospective cohort open label multicenter study in three major general hospitals in Athens,
Greece, all 210 patients undergoing hip arthroplasty during a period of one calendar year ending December 25, 1998 underwent face-to-face interviews after surgery and for 4 consecutive postoperative days. A Visual Analogue Scale (VAS) was used to measure intensity of pain on a continuous scale with the ends marked as “no pain” (0mm) and “worst pain ever” (100mm) twice daily. After controlling for demographics and ASA status, the study arms were compared on the basis of physician-suggested clinically meaningful pain intervals of: 0–30VAS (excellent analgesia), 31–50VAS (good analgesia), 51–70VAS (bad analgesia) and 71–100VAS (insufficient analgesia). Ordinary least square regressions were run with pain intensity as dependent variable and clinical, organizational, physician and patient characteristics as independent ones. RESULTS: Immediately after surgery, EA and GEA present statistically significant higher numbers of patients in the 0–30VAS interval than the rest two anesthesia techniques (p 0.005). EA and GEA also show lower numbers of patients at the “bad” and “insufficient” analgesia intervals at a statistically significant level during the study period, except for the third postoperative day. In regression analysis, locus of postoperative pain management responsibility, analgesia technique, and hospital practice variations significantly accounted for clinically meaningful differences in postoperative pain levels. CONCLUSIONS: Epidural and general/epidural anesthetic techniques result in more patients with excellent analgesia immediately after hip arthroplasty. The use of continuous postoperative epidural analgesia (CEPA) technique together with assigning anesthesiologists responsibility for post operative pain management result in better pain relief during a period of 4 postoperative days.
PCP9
THE ANALGESIC EFFICACY AND THERAPEUTIC ONSET OF ANALGESIA OF INTRAVENOUS AND INTRAMUSCULAR KETOROLAC (15 MG AND 30 MG), AND ORAL IBUPROFEN 800 MG IN THE EMERGENCY ROOM: A COMPARATIVE STUDY Habib M1, Brofeldt B2, Supernaw B3 1 University of Texas, Austin, TX, USA; 2University of California Davis Medical Center, Davis, CA, USA; 3Texas Technological University, Amarillo, TX, USA Although pain is the most common presenting complaint in emergency rooms (ERs), few ERs have written policies on pain management. The Canadian Association of Emergency Physicians recommends that to achieve rapid and safe analgesia, parenteral use of medications should be restricted to the intravenous (IV) route. The analgesic efficacy of ketorolac after IV and IM administration has not been investigated. Ibuprofen 800 mg has been demonstrated to provide comparable analgesia to IM ketorolac 30 mg. OBJECTIVE: To evaluate the analgesic efficacy and therapeutic onset of analgesia of parenteral ketorolac and oral ibuprofen.
Abstracts tion in relation to subsequent statements, therefore appropriate clarifications had to be added. The response scale “very completely, completely, average, incompletely, very incompletely” was impossible to translate literally. The following equidistant responses were substituted: “completely, quite a bit, average, a little bit, not at all.” CONCLUSIONS: A rigorous translation methodology was performed to ensure conceptual equivalence and acceptability of translations. International feedback obtained through the translation process revealed issues regarding the original instrument, indicating that future amendments to the original may be necessary. Psychometric testing will be conducted to ensure reliability and validity of each translation, appropriateness of the questionnaire in each country, and comparability of data across countries.
PCP5
USE OF OPIOID ANALGESICS FOR NONMALIGNANT PAIN CONDITIONS: A CROSS-SECTIONAL CHARACTERIZATION Sesti AM, Dodd SL, Rai RB, Wilson J Janssen Research Foundation, Titusville, NJ, USA OBJECTIVE: The purpose of this study was to evaluate prescribing of opioid analgesics for the treatment of nonmalignant pain conditions. METHODS: The 1995 MarketScan® database was used to identify patients without malignant diagnoses and at least one prescription for an opioid. The resulting cohort was classified into three mutually exclusive categories: transdermal fentanyl (TDF, n 118), long-acting opioids (LA, n 136), and short-acting opioids (SA, n 92,412). Demographics, diagnosis categories, and resource utilization (outpatient, inpatient, and prescription claims) were examined. RESULTS: The number of patients in the SA group was disproportionately larger than the other groups preventing a direct comparison. Their average age was 40 years, primarily female, and 71% working full time. The most common diagnosis category was musculoskeletal (MSK) and lumbago was the most frequent condition. For comparative purposes, we examined diagnoses groups and resource utilization for the TDF and LA groups. Age, gender, and employment status was similar for both groups. The MSK category and lumbago diagnoses were also the most common conditions. TDF patients had more lumbago physician visits but less cost/patient compared to the LA group (median 6 visits, $49.50 versus 2.5 visits, $74.50, respectively). Inpatient use was similar between groups with a median of two occurrences/patient. The median prescription use/patient of TDF was slightly less than LA (3 versus 4.5) and both groups used a similar number of other opioid analgesics (median 13). CONCLUSION: This study suggests a similar distribution of conditions associated with the use of TDF, LA, and SA opioids. However, SA opioid utilization in nonmalignant pain differs from TDF and LA agents. Further
analysis is necessary to identify characteristics that differentiate these groups.
PCP6
OPIOID ANALGESICS USE IN PATIENTS WITH NONMALIGNANT PAIN: SELECTING AN APPROPRIATE COMPARISON GROUP Loughlin JE1, Walker AM1, Cole JA1, Wilson J2, Dodd SL2, Sesti A-M2 1 Epidemiology Resources Inc., Newton, MA, USA; 2Janssen Research Foundation, Titusville, NJ, USA OBJECTIVE: The purpose of the study is to compare the resource utilization and costs related to the total medical care of Duragesic patients with those incurred by patients who have been prescribed long-acting opioids. This abstract focuses on the methodology utilized to select a comparison group for the Duragesic patients. METHODS: We identified all patients without cancer in a New England insurer database with at least one prescription for Duragesic from January 1, 1995 through December 31, 1997. We required each patient to be enrolled 30 days prior to the prescription index date and the ensuing 90 days, and to have drug benefits (n 420). We similarly identified patients with at least one prescription for a long-acting opioid (n 1239). We characterized the patients by age, gender, health services utilized, costs incurred, diagnosis, and drugs dispensed in the 30 days prior the index date. RESULTS: Duragesic and long-acting opioid patients had similar distributions of age, sex, and inpatient and outpatient diagnoses. For both groups, musculoskeletal/ connective tissue conditions were among the most frequent diagnoses, and costs were highest in the month preceding the first opioid dispensing, dropping by about 50% over the ensuing 90 days. CONCLUSIONS: Patterns of health resource utilization and cost are similar for the two groups. Total costs incurred are highest in the 30 days prior to the initial dispensing and drop considerably during the following 90 days. There is overlap among the non-malignant conditions treated with Duragesic and long-acting opioids. These results suggest that it may be possible to identify a useful and appropriate comparison group for the Duragesic patients.
PCP7
COSTS AND OUTCOMES OF REGIONAL VERSUS GENERAL VERSUS COMBINATION ANESTHESIA AND ANALGESIA TECHNIQUES IN GREEK PATIENTS UNDERGOING HIP ARTHROPLASTY Yfantopoulos Y1, Athanasiadis H2, Karokis A3, Tsekouras V3, Yourgioti G3, Pierrakos G1, Karamihali E4, Hantziandreou E5 1 University of Athens, Athens, Greece, 2Hellenic Airforce Hospital, Athens, Greece, 3Astra Hellas, Athens, Greece, 4 Evangelismos Hospital, Athens, Greece, 5ASTRA A.B, Athens, Greece
208
Abstracts
OBJECTIVE: To compare the costs and effectiveness of general (GA) versus regional (RA) versus combination (general/epidural) (GEA) of anesthetic/analgesic techniques in patients undergoing hip arthroplasty. METHOD: In a prospective cohort open label multicenter study in three major general hospitals in Athens, all 210 patients undergoing hip arthroplasty during a period of one calendar year ending December 25, 1998 were studied. Patients were eligible for all anesthesia techniques. Doctors followed their current anesthesia/analgesia technique. Total costs included all pre-, intra-, and postoperative direct medical costs (health system perspective). Resource use was recorded and per hospital unit prices were transformed to US dollars. Effectiveness was measured by classifying patients in four intervals of pain intensity along a linear Visual Analogue Scale (0–30VAS “excellent” analgesia, 31–50VAS “good” analgesia, 51–70VAS “bad” analgesia, and 71–100VAS “insufficient” analgesia). Separate cost and effectiveness analyses were performed and a stochastic cost-effectiveness analysis model is being used to calculate incremental cost-effectiveness ratios. RESULTS: Significant total-costs differences exist amongst anesthetic/analgesic techniques (p 0.001). GA presented higher operative costs than RA, whereas GEA presented the highest postoperative costs. GEA showed clinically and statistically significant lower pain scores at recovery room and during the 4 postoperative days (p 0.001). Preliminary results indicate that a moderate increase in costs through applying continuous postoperative epidural analgesia (CEPA) is associated with better pain relief indicated by lower numbers of patients in “bad” and “insufficient” analgesia levels. CONCLUSIONS: Despite a moderate postoperative cost increase, epidural anesthesia/analgesia and GEA result in clinically significant improvements in patients’ pain relief during the study period. Postoperative pain management practices are key factors influencing the direction and magnitude of costs and effects of the various anesthesia/ analgesia techniques.
PCP8
ASSESSMENT OF SURGICAL ANESTHESIA AND POSTOPERATIVE ANALGESIA USING A PAIN VISUAL ANALOG SCALE Yfantopoulos Y1, Athanasiadis A2, Karokis A3, Tsekouras V3, Yourgioti G3, Pierrakos G1, Pagouni H4, Hantziandreou E5 1 University of Athens, Athens, Greece, 2Hellenic Airforce Hospital, Athens, Greece, 3Astra Hellas, Athens, Greece, 4 Nikea General Hospital, Athens, Greece, 5ASTRA A.B, Athens, Greece OBJECTIVE: To compare the effectiveness of general (GA) versus epidural (EA) versus spinal (SA) versus a combination (GEA) anesthetic technique in terms of pain relief for patients undergoing hip arthroplasty. METHOD: In a prospective cohort open label multicenter study in three major general hospitals in Athens,
Greece, all 210 patients undergoing hip arthroplasty during a period of one calendar year ending December 25, 1998 underwent face-to-face interviews after surgery and for 4 consecutive postoperative days. A Visual Analogue Scale (VAS) was used to measure intensity of pain on a continuous scale with the ends marked as “no pain” (0mm) and “worst pain ever” (100mm) twice daily. After controlling for demographics and ASA status, the study arms were compared on the basis of physician-suggested clinically meaningful pain intervals of: 0–30VAS (excellent analgesia), 31–50VAS (good analgesia), 51–70VAS (bad analgesia) and 71–100VAS (insufficient analgesia). Ordinary least square regressions were run with pain intensity as dependent variable and clinical, organizational, physician and patient characteristics as independent ones. RESULTS: Immediately after surgery, EA and GEA present statistically significant higher numbers of patients in the 0–30VAS interval than the rest two anesthesia techniques (p 0.005). EA and GEA also show lower numbers of patients at the “bad” and “insufficient” analgesia intervals at a statistically significant level during the study period, except for the third postoperative day. In regression analysis, locus of postoperative pain management responsibility, analgesia technique, and hospital practice variations significantly accounted for clinically meaningful differences in postoperative pain levels. CONCLUSIONS: Epidural and general/epidural anesthetic techniques result in more patients with excellent analgesia immediately after hip arthroplasty. The use of continuous postoperative epidural analgesia (CEPA) technique together with assigning anesthesiologists responsibility for post operative pain management result in better pain relief during a period of 4 postoperative days.
PCP9
THE ANALGESIC EFFICACY AND THERAPEUTIC ONSET OF ANALGESIA OF INTRAVENOUS AND INTRAMUSCULAR KETOROLAC (15 MG AND 30 MG), AND ORAL IBUPROFEN 800 MG IN THE EMERGENCY ROOM: A COMPARATIVE STUDY Habib M1, Brofeldt B2, Supernaw B3 1 University of Texas, Austin, TX, USA; 2University of California Davis Medical Center, Davis, CA, USA; 3Texas Technological University, Amarillo, TX, USA Although pain is the most common presenting complaint in emergency rooms (ERs), few ERs have written policies on pain management. The Canadian Association of Emergency Physicians recommends that to achieve rapid and safe analgesia, parenteral use of medications should be restricted to the intravenous (IV) route. The analgesic efficacy of ketorolac after IV and IM administration has not been investigated. Ibuprofen 800 mg has been demonstrated to provide comparable analgesia to IM ketorolac 30 mg. OBJECTIVE: To evaluate the analgesic efficacy and therapeutic onset of analgesia of parenteral ketorolac and oral ibuprofen.