Cost-effectiveness analysis of anesthetic agents during peripheral intravenous cannulation in the pediatric emergency department

Jay Pershad, Stephanie C. Steinberg, Teresa Waters

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: To conduct a cost-effectiveness analysis of anesthetic agents to reduce the pain of peripheral intravenous cannulation in an emergency department (ED) setting. Design: Cost-effectiveness analysis in which costs were measured as the cost of the agent plus costs associated with time in the ED using data from our hospital cost accounting system. Outcomes were measured as improvements in the self-reported visual analog scale (VAS) pain scores. Variables considered unique to the various agents were cost of the agent, time to peak onset, success rates of cannulation, and mean reduction in VAS scores. Setting: Decision model. Patients: A cohort of patients aged 3 through 18 years enrolled in randomized controlled trials that compared analgesic modalities to facilitate peripheral intravenous cannulation was identified through medical databases searched from their inception (earliest year, 1966) through June 2007. Main Outcome Measures: The main outcome measure was the incremental cost-effectiveness ratio, which represented the additional cost that must be incurred by the hospital to obtain a reduction of 1 additional unit (10 mm or 1 cm) in the VAS score compared with a baseline option of no anesthetic. Results: Our results suggest that the needle-free jet injection of lidocaine device had the lowest incremental cost-effectiveness ratio, followed by intradermal injection of buffered lidocaine; lidocaine iontophoresis; nitrous oxide inhalation analgesia; a heated lidocaine and tetracaine patch; sonophoresis with lidocaine cream, 4%; lidocaine cream alone, 4%; and use of a eutectic mixture of lidocaine and prilocaine cream. Conclusion: Currently, the needle-free jet injection of lidocaine device and injection of buffered lidocaine appear to provide the most cost-effective alternatives to pediatric ED physicians.

Original languageEnglish (US)
Pages (from-to)952-961
Number of pages10
JournalArchives of Pediatrics and Adolescent Medicine
Volume162
Issue number10
DOIs
StatePublished - Oct 1 2008

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Lidocaine
Catheterization
Cost-Benefit Analysis
Anesthetics
Hospital Emergency Service
Pediatrics
Costs and Cost Analysis
Jet Injections
Visual Analog Scale
Needles
Outcome Assessment (Health Care)
Tetracaine
Intradermal Injections
Iontophoresis
Equipment and Supplies
Hospital Costs
Nitrous Oxide
Pain Measurement
Analgesia
Inhalation

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Cost-effectiveness analysis of anesthetic agents during peripheral intravenous cannulation in the pediatric emergency department. / Pershad, Jay; Steinberg, Stephanie C.; Waters, Teresa.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 162, No. 10, 01.10.2008, p. 952-961.

Research output: Contribution to journalArticle

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