| Title |
Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis
|
|---|---|
| Published in |
Breast Cancer Research and Treatment, July 2017
|
| DOI | 10.1007/s10549-017-4371-9 |
| Pubmed ID | |
| Authors |
Anaeze C. Offodile, Clifford C. Sheckter, Austin Tucker, Anna Watzker, Kevin Ottino, Martin Zammert, William V. Padula |
| Abstract |
Preoperative paravertebral blocks (PPVBs) are routinely used for treating post-mastectomy pain, yet uncertainties remain about the cost-effectiveness of this modality. We aim to evaluate the cost-effectiveness of PPVBs at common willingness-to-pay (WTP) thresholds. A decision analytic model compared two strategies: general anesthesia (GA) alone versus GA with multilevel PPVB. For the GA plus PPVB limb, patients were subjected to successful block placement versus varying severity of complications based on literature-derived probabilities. The need for rescue pain medication was the terminal node for all postoperative scenarios. Patient-reported pain scores sourced from published meta-analyses measured treatment effectiveness. Costing was derived from wholesale acquisition costs, the Medicare fee schedule, and publicly available hospital charge masters. Charges were converted to costs and adjusted for 2016 US dollars. A commercial payer perspective was adopted. Incremental cost-effectiveness ratios (ICERs) were evaluated against WTP thresholds of $500 and $50,000 for postoperative pain control. The ICER for preoperative paravertebral blocks was $154.49 per point reduction in pain score. 15% variation in inpatient costs resulted in ICER values ranging from $124.40-$180.66 per pain point score reduction. Altering the probability of block success by 5% generated ICER values of $144.71-$163.81 per pain score reduction. Probabilistic sensitivity analysis yielded cost-effective trials 69.43% of the time at $500 WTP thresholds. Over a broad range of probabilities, PPVB in mastectomy reduces postoperative pain at an acceptable incremental cost compared to GA. Commercial payers should be persuaded to reimburse this technique based on convincing evidence of cost-effectiveness. |
X Demographics
The data shown below were collected from the profile of 1 X user who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 40 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 40 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 7 | 18% |
| Student > Doctoral Student | 6 | 15% |
| Student > Master | 5 | 13% |
| Other | 4 | 10% |
| Professor | 3 | 8% |
| Other | 7 | 18% |
| Unknown | 8 | 20% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 22 | 55% |
| Pharmacology, Toxicology and Pharmaceutical Science | 4 | 10% |
| Business, Management and Accounting | 2 | 5% |
| Nursing and Health Professions | 2 | 5% |
| Economics, Econometrics and Finance | 1 | 3% |
| Other | 2 | 5% |
| Unknown | 7 | 18% |
Attention Score in Context
This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 09 October 2021.
All research outputs
#6,481,248
of 22,985,065 outputs
Outputs from Breast Cancer Research and Treatment
#1,421
of 4,675 outputs
Outputs of similar age
#103,452
of 313,617 outputs
Outputs of similar age from Breast Cancer Research and Treatment
#32
of 83 outputs
Altmetric has tracked 22,985,065 research outputs across all sources so far. This one has received more attention than most of these and is in the 70th percentile.
So far Altmetric has tracked 4,675 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 7.2. This one has gotten more attention than average, scoring higher than 68% of its peers.
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We're also able to compare this research output to 83 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 61% of its contemporaries.