Cost of Intravenous Analgesia for the Management of Acute Pain in the Emergency Department is Substantial in the United States

Budget Impact and Cost-Effectiveness of Intravenous Meloxicam to Treat Moderate-Severe Postoperative Pain

INTRODUCTION

This study assesses the budget impact and cost-effectiveness of intravenous meloxicam (MIV) to treat moderate-severe acute postoperative pain in adults.

METHODS

A two-part Markov cohort model captured the pharmacoeconomic impact of MIV versus non-opioid intravenous analgesics (acetaminophen, ibuprofen, ketorolac) among a hypothetical adult cohort undergoing selected inpatient procedures and experiencing moderate-severe acute postoperative pain: Part 1 (postoperative hour 0 to discharge, cycled hourly), health states were defined by pain level. Pain transition rates, adverse event probabilities, and concomitant opioid utilization were derived from a network meta-analysis. Part 2 (discharge to week 52, cycled weekly), health states were defined by the presence/absence of pain-related readmission and opioid use disorder as determined by literature-based inputs relating to pain control outcomes. Healthcare utilization and direct medical costs were derived from an administrative claims database analysis. Primary outcomes were the incremental cost per member per month (PMPM) and cost per quality-adjusted life year (QALY) gained. Scenario, univariate, and probabilistic sensitivity analyses were conducted. The model assumed a private payer perspective in the USA (no discounting, 2019 US$).

RESULTS

Modeled outcomes indicated MIV was associated with lower accumulated postoperative pain, fewer adverse events, and less opioid utilization for most procedures and comparators, with longer-term outcomes also generally favoring MIV. The budget impact of MIV was - $0.028 PMPM. From a cost-effectiveness perspective, MIV had lower costs and better outcomes for all comparisons except against ketorolac in orthopedic procedures where the former was cost-effective but not cost saving ($95,925/QALY). Scenario and sensitivity analyses indicated that modeled outcomes were robust to alternative inputs and underlying input uncertainty. Differences in direct medical costs were driven by reduced costs attributable to length of stay and opioid-related adverse drug events.

CONCLUSION

MIV was associated with modeled clinical and economic benefits compared to commonly used non-opioid intravenous analgesics.

Healthcare resource use and cost implications of low dose methoxyflurane for severe trauma-related pain: a qualitative study

Aims

Management of moderate-to-severe trauma-associated pain is often reported as suboptimal, due in part to limitations associated with frequently used analgesics. Low-dose methoxyflurane (LDM) is an inhaled, non-opioid analgesic, recently approved for emergency relief of moderate-to-severe trauma-associated pain in conscious adults. This study assessed the perspective of healthcare professionals (HCPs) with regard to the time to analgesia and healthcare cost of LDM versus morphine IV, for patients with severe trauma-related pain receiving emergency care in Belgium.

Materials and methods

Interviews and questionnaires were completed by four healthcare HCPs providing emergency care at different hospitals in Belgium. Processes describing analgesic provision in pre-hospital and hospital emergency department (ED) settings were qualitatively mapped and a cost model applied which included reimbursed analgesic costs, time spent by HCPs making analgesic treatment decisions, preparing and administering the analgesic, and post-dose monitoring and management of analgesic-related adverse events (AEs).

Results

LDM was associated with substantial time and costs savings per patient, largely due to no requirement for AE monitoring. Compared with morphine IV, LDM in the hospital ED was associated with a time saving of 4 minutes to analgesic provision (35 vs 39 min) and ≥224 min in total (35 vs ≥259 min; including monitoring and managing AEs). In the pre-hospital setting, LDM was also associated with a time saving of 4 minutes to analgesic provision (21 vs 25 min) and 198 minutes in total. The corresponded total cost savings with LDM vs morphine IV were ≥€27.32 and ≥€17.95 in the ED or prehospital setting, respectively.

Conclusions

The cost model showed that LDM was associated with substantial time and costs savings versus morphine IV for severe trauma-related emergency pain in pre-hospital and hospital ED settings in Belgium.

Pooled Dosing and Efficacy Analysis of the Sufentanil Sublingual Tablet 30 mcg Across Demographic Subgroups for the Management of Moderate-to-Severe Acute Pain

PURPOSE

To aid nurses in dosing sufentanil sublingual tablet (SST) 30 mcg administered via a single-dose applicator, dosing requirements and efficacy of SST 30 mcg were analyzed across age, sex, race, and body mass index subgroups.

DESIGN

Patient characteristics were pooled from three postoperative studies (two placebo-controlled and one open-label) and one open-label emergency department study. Drug dosing and efficacy data were pooled from the postoperative studies.

METHODS

Efficacy was assessed through summed pain intensity difference to baseline during 12 hours across subgroups.

FINDINGS

Mean (standard deviation) drug doses administered from 0 to 12 hours was 3.9 (2.0) for SST 30 mcg and was less frequent for older (≥65 years) versus younger patients. The summed pain intensity difference to baseline during 12 hours was superior with SST 30 mcg versus placebo across all subgroups.

CONCLUSIONS

SST 30 mcg is a sublingual opioid analgesic with efficacy across demographic subgroups.

Sufentanil Sublingual Tablet: A New Option for Acute Pain Management

Objective: The purpose of this article is to review the safety and efficacy of sufentanil sublingual tablet (SST) and suggest its place in therapy for managing acute pain in patients requiring intravenous (IV) opioids. Data Sources: A MEDLINE/PubMed search was performed (2010 to April 2019) using the following keywords: sufentanil sublingual tablet, sufentanil, opioid, moderate to severe acute pain. Study Selection and Data Extraction Quantification: We included English language articles evaluating SST pharmacology, pharmacokinetics, efficacy, and safety in humans for the treatment of acute pain. Data Synthesis: SST is Food and Drug Administration approved and considered safe and effective for the treatment of acute pain in Risk Evaluation and Mitigation Strategy–certified and medically supervised health care settings. Phase III clinical trials showed a statistically significant decrease in summed pain intensity score when SST was compared with placebo. Relevance to Patient Care and Clinical Practice: SST can be a useful option in patients requiring a parenteral opioid who do not have IV access, or it may be unnecessary or difficult to obtain. Because of its quick onset and sustained analgesia, SST may also be useful for procedural pain in the critically ill, to expedite discharges for outpatient procedures, in emergency departments (EDs), and in the battlefield. Conclusions: SST can satisfy an unmet need in patients with acute pain, who require parenteral opioids, and either have no IV access or require prolonged time to achieve IV access such as patients in outpatient surgical centers, EDs, and the battlefield. During periods of parenteral opioid shortage, SST may provide another option for adequate analgesia.