Patient Reported Outcomes and Post-Operative Pain Management Treatment

Post-operative pain management is an arena that is ripe for innovation and improvement. Over the past several years the options for managing surgical pain while in recovery have remained largely the same, involving a range of pharmacological interventions, along with other types of therapy, but policies remain tightly tied to individual practitioners. A poster presentation by J Abraham et al in partnership with ICON (Greta Lozano-Ortega and Kristine Ogden) at the 2015 ISPOR conference in Philadelphia, PA, explored the potential impact that the introduction of patient satisfaction metrics could have on these pain management decisions.

The study methodology employed by J Abraham et al spoke with a group drawn from orthopedic and gynecology surgical specialties as well as general surgeons. By way of an online survey, these surgeons were asked a number of questions regarding how they interpreted a multimodal therapy strategy (breaking down into an analysis of opioid use, analgesic use, and non-opioid treatments), and how pain management drugs were delivered to the patient.

The study also addressed nine specific attributes associated with pain control management at a total of 28 levels, including a patient's satisfaction with pain control, patient mobility, cost per day, the use of nursing staff, type of medication used and how that medication was administered, analgesic gaps, overall pain control, and adverse event profiles. These were then plotted to distribute their importance according to each surgical specialty.

The results showed an almost universal prioritization of patient satisfaction with pain control, followed closely by mobility, the ability to reduce the occurrence of adverse events, and overall pain control effectiveness by each surgical specialty. The study also illustrated that surgeons depended on opioids as the backbone of their multimodal pain management approach. With patient mobility and patient satisfaction with pain management the top two considerations in developing a post-surgical strategy, it seems clear that patient reported outcomes are as important to clinicians, if not more so, than merely considering the safety and efficacy of a given pharmacological intervention.

An Economic Analysis of Postoperative Pain Management with Fentanyl ITS

Managing postoperative pain has long been the province of intravenous, patient-controlled analgesic (PCA) systems, typically making use of morphine as a pain reliever. A recent ISPOR poster presentation by Abraham J, et al, entitled 'An Economic Analysis of Postoperative Pain Management with Fentanyl Iontophoretic Transdermal System,' takes a look at an alternative to traditional PCA systems from a cost/benefit perspective. Specifically, the poster contrasts the most common clinical patient-controlled analgesic setups with a new iontophoretic system (ITS) used to deliver fentanyl instead of morphine.

The economic benefits of moving to a non-IV PCA system center around the reduction in hospital or clinic resources associated with IV maintenance, including staff time and the supplies and equipment involved. Of course, in evaluating the replacement of a morphine IV with a fentanyl ITS, the poster considered not just resource use but also the safety outcomes related to device errors and opioid adverse events. A time window of 48 hours was used to model the overall impact of the ITS replacement on orthopedic surgical inpatients.

The results of the study indicated that moving to a fentanyl ITS provided immediate benefits in resource management. The amount of time spent by hospital staff per patient dropped from 109 minutes for a morphine IV to 34 minutes for the iontophoretic system. Concurrently, this also resulted in 38% reduction in administration tasks (including pharmacy staff responsibilities) that translated into a $50 savings per patient. Overall, when taking into account the entire 48 hours of care, the study was able to demonstrate a $579 per patient savings through the use of the fentanyl ITS (less fentanyl acquisition costs).