Students

Name: Angel Lau Suk-Chu

Enrolled: September 2005 – August 2008

Origin: Hong Kong

Supervisor: Prof. Anna Lee, Prof. Tony Gin

Title of Thesis:

A cost-effectiveness analysis of an acute pain servic

Outline of the Thesis:

Background: In anaesthesia, managing acute pain in the postoperative period is an important component of perioperative care. An Acute Pain Service (APS) is a dedicated service for managing acute pain in patients who have undergone surgery. The APS is run by a professional team of anaesthesiologists with or without nurses. Although most public hospitals in Hong Kong have an APS, only 20% of patients undergoing a major operation receive this care. Given that there are increasing healthcare interventions competing for limited resources, cost-effectiveness analysis can be used to determine if an intervention is worthwhile to support. As no cost-effectiveness analysis of an APS intervention in Hong Kong has been carried out, this represents a gap in knowledge in public health policy.

Objective: To examine whether APS is cost-effective compared to conventional ward postoperative pain service (CWPS) from a hospital’s perspective.

Methods: I participated in the conduct of a systematic review of the literature on the economic evaluation of APS programs and performed a cost-effectiveness analysis alongside a randomized controlled trial (RCT) of APS care in 260 patients undergoing major elective surgery. The main outcomes of the trial were comparison of cost and measures of effectiveness between APS and CWPS. Cost was defined as the combined value of total hospital cost (cost of care in ward and intensive care unit) and total pain cost (costs of pain medication and side-effects medication and APS staffing). The primary measure of effectiveness was the level of pain after surgery using verbal rating scales. Other measures of effectiveness included patient satisfaction, side-effects of analgesia and quality of recovery (QoR) using validated and reliable questionnaires.

Results: The results of the systematic review showed that there was insufficient evidence to draw conclusions about the cost-effectiveness and cost-benefit of Acute Pain Services (APSs). The overall quality of published economic evaluations of APSs was poor. There was no high quality economic study to support the cost-effectiveness and cost-benefits of APSs. Data from the RCT showed that the overall cost of APS care was no more expensive than CWPS (mean difference per patient = HK$7,490, 95% confidence interval: HK$-4,019 to HK$18,999, p=0.22). The APS was more effective than CWPS in the area of perceived pain-relief effectiveness (p=0.01). Compared to CWPS patients (89%), more APS patients (98%) thought that their pain medication and other treatment in relieving postoperative pain were helpful (p=0.01). The two pain services were similar in their impact on the levels of pain severity at rest (p=0.45) or on movement (p=0.17), pain interference on daily activities on postoperative days two and three (p=0.87 and p=0.86 respectively), side effects of pain medications (p=0.97) and health-related QoR (p=0.25). Of note, compared to CWPS patients, there was less interference of pain on daily activities on the first day after surgery in patients receiving APS care (mean verbal numerical scale out of 10 = 3.4 versus 2.6 respectively, p=0.02).

Conclusion: There is some evidence that APS is cost-effective. APS is a worthwhile intervention to support from a hospital’s perspective.

Publications arising from her research work:

(A) Scientific Paper:

1. Lee, A., Chan, S., Chen, P.P., Gin, T. & Lau, S.C. (2007). Economic evaluation of Acute Pain Service programs: A systematic review. Clin J Pain 2007; 23(8): 726-733.

(B) Conference Abstracts:

2. Lau, S.C., Lee, A., Chan, S., Chen, P.P., & Gin, T. (2006, November 19). Economic evaluation of Acute Pain Service programs: A qualitative systematic review. Paper presented at the Annual Scientific Meeting in Anaesthesiology 2006 of the Hong Kong College of Anaesthesiologists and the Society of Anaesthetists of Hong Kong, HKSAR, China.
   
   
3. Lau, S.C., Lee, A., Chan, S., Chen, P.P., & Gin, T. (2007, November 17). Patient satisfaction with pre-operative pain management. Paper presented at the Annual Scientific Meeting in Anaesthesiology 2007 of the Hong Kong College of Anaesthesiologists and the Society of Anaesthetists of Hong Kong, HKSAR, China.

(C) Poster presentation:

4. Gin, T, Lee, A, Lau, ASC, Chen, PP, Chan, S. Acute Pain Service is cost neutral: Preliminary results. Poster presented at the World Congress in Pain 2008, Glasgow.