Duramorph –A Cost Analysis

Scott Frankfather, M.D. PGY IVRobert Casanova, M.D. Texas Tech PhysiciansDepartment of Obstetrics and GynecologyMarch 6, 2009

Duramorph—A Cost Analysis

• Objective: To evaluate the cost effectiveness of intrathecal morphine during spinal anesthesia for cesarean section.

Duramorph—A Cost Analysis

• Background: Cesarean section is the most commonly performed surgery in the United States. 26% of all deliveries in 2002.

– Anesthesia includes» Epidural » Spinal» General» Local

Duramorph—A Cost Analysis

• Background:– The most common types of anesthesia:

» epidural or spinal anesthesia.

– The addition of morphine to the intrathecal (spinal) anesthesia is becoming a more common practice

» pain relief for up to twenty-four hours» Negates need for patient controlled analgesia

(PCA)

– Patients require additional medications» Oral narcotics» Intravenous or intramuscular narcotics» Antihistamines» Antiemetics

Duramorph—A Cost Analysis

• Background:– A review of literature in PubMed found no

study evaluating the cost-effectiveness of intrathecal morphine.

Duramorph—A Cost Analysis

• Study Design: – Retrospective chart review comparing

medication costs of patients receiving intrathecal morphine anesthesia and matched controls of patients receiving spinal anesthesia with PCA between January 1, 2008 and December 31, 2008 at University Medical Center.

Duramorph—A Cost Analysis

– Hypothesis: Intrathecal morphine provides adequate pain relief but is not cost effective when considering all additional medications required by the patient.

Duramorph—A Cost Analysis

• Materials and Methods:– The patients were identified using the

Premier software with the assistance of the office of Performance Improvement at University Medical Center in Lubbock, Texas.

– The costs of all anesthesia related medications following a cesarean section were analyzed.

Duramorph—A Cost Analysis

• Materials and Methods: – After identifying patients of interest and obtaining

the total cost of medications of interest, all patient identifiers were removed from the data.

– Data collected included:

• Gravidity• Parity• Weight• Type of anesthesia• Skin incision

• Cost of all pain medication

• Cost of medication resulting from administration of anesthesia.

Duramorph—A Cost Analysis

• Materials and Methods:– Population: 617 patients who underwent a

cesarean section between January 1, 2008 and December 31, 2008.

– Subdivided into groups according to type of anesthesia

• Duramorph Group: 54 Patients • PCA Group: 104 Patients were selected

randomly from 517 who received spinal with PCA

Duramorph—A Cost Analysis

• Materials and Methods:– Exclusion criteria:

• Hospital stays longer than 7 days– n=3 from Duramorph group– n=32 from PCA group

• Incomplete medical records (n=2)• Duplicated anesthesia charges (n=18)• No anesthesia charges (n=28)

Results

Type of

Anesthesia

Number

Of

Patients

Individual

Cost

Additional

Costs

Total

Cost

Duramorph 54 $3.93 $14.43 $18.14

PCA 517 $18.76 $15.50 $33.76

Total

C-sections

617

Results

Duramorph PCA

Age 28.76 24.69

Weight 91.00 90.48

Gravidity 2.74 2.27

Parity 1.32 0.93

Cesarean # 1.91 1.58

Results

Duramorph PCA

Total Cost $16.92 $24.20

Individual Cost $3.76 $18.10

Other Costs $13.38 $16.10

Total Charges $3552.11 $3888.43

Length of Stay 3.16 days 3.55 days

Average costs of medications excluding the cost of PCA pump

Conclusion

• Intrathecal morphine provides adequate pain relief and is cost effective when considering all additional medications required by the patient. A direct comparison of the mean medication cost reveals a statistically significant yet small savings; however, the amount saved by using Duramorph spinal is $336.32 per patient when considering all charges to the patient.

References

• Cunningham, Leveno, et al.  Willimas Obstetrics. 22nd ed.  New York: McGraw-Hill, 2005. 473-490, 588-590.

• Gabbe, Niebyl, et al.,eds.  Obstetrics: Normal and Problem Pregnancies.  4th ed. Philadelphia: Churchill Livingston, 2002. 539-543, 458-465

Thank You

• Dr. Casanova

• Dr. Prien

• Karen Lemons

• Shane Terrell

• Todd Jackson, RPh.