Activity-based cost analysis of opioid-related nausea and vomiting among inpatients

Authors

  • Leopold Eberhart, MD
  • Tilo Koch, MSc
  • Peter Kranke, MD
  • Dirk Rüsch, MD
  • Alexander Torossian, MD
  • Stefan Nardi-Hiebl, MBA

DOI:

https://doi.org/10.5055/jom.2014.0238

Keywords:

, nausea (opioid-related), vomiting (opioid-related), opioids (side effects), economic analysis, activity-based costing

Abstract

Objective: Nausea and/or vomiting (N/V) are frequent side effects of opioid drugs. These are of major concerns to patients and caregivers and only few studies have focused on their economical costs.

Design: This is a prospective, nonproduct-related, activity-based evaluation of personnel and material costs of opioid-related N/V among inpatients.

Setting: Data were obtained from surgical, general medicine, and palliative care wards at 16 German hospitals of different size, healthcare mandate, and ownership.

Patients, participants: According to predefined criteria, of 462 documented N/V events, 340 were diagnosed as opioid related.

Interventions: Elicited activities and pharmacological interventions for N/V episodes followed local standards.

Main outcome measure: Both materials used and the time engaged to treat patients with N/V were documented on an “ad hoc” activity recording form. The total cost of an opioid-related N/V episode was calculated based on standard wages of the involved personnel and standard costs of the inherent materials used.

Results: Mean staff tenure time for handling an episode of N/V was 26.2 ± 19.8 minutes (nausea 16.9 ± 28.7 minutes; nausea + vomiting: 33.4 ± 26.8 minutes). In the German context, this corresponds to average personnel costs of 18.06 ± 13.64. Material cost contributes to another 13.49 ± 13.38 of costs mainly depending on acquisition costs of antiemetic drugs.

Conclusions: N/V showed to have impact on workload of nurses and (to lesser extent) physicians and economic burden of 31 ± 22 for each N/V episode. In view of these results, the potential costs of strategies to minimize the incidence of N/V (use of antiemetics and/or the use of new analgesics) should be outweighed against the incurred costs of N/V.

Author Biographies

Leopold Eberhart, MD

Department of Anesthesiology & Intensive Care Medicine, Philipps-University Marburg, Marburg, Germany.

Tilo Koch, MSc

Department of Anesthesiology & Intensive Care Medicine, Philipps-University Marburg, Marburg, Germany.

Peter Kranke, MD

Department of Anesthesia and Critical Care, University of Würzburg, Würzburg

Dirk Rüsch, MD

Department of Anesthesiology & Intensive Care Medicine, Philipps-University Marburg, Marburg, Germany.

Alexander Torossian, MD

 Department of Anesthesiology & Intensive Care Medicine, Philipps-University Marburg, Marburg, Germany.

Stefan Nardi-Hiebl, MBA

 Department of Anesthesiology & Intensive Care Medicine, Philipps-University Marburg, Marburg, Germany; 5Med GmbH, Bad Abbach, Germany.

 

References

Lapane KL, Quilliam BJ, Benson C, et al.: Gastrointestinal events after opioid treatment in nonmalignant pain: Correlates of occurrence and impact on health-related quality of life. J Opioid Manag. 2013; 9(3): 205-216.

Portenoy RK, Farrar JT, Backonja MM, et al.: Long-term use of controlled-release oxycodone for noncancer pain: Results of a 3-year registry study. Clin J Pain. 2007; 23(4): 287-299.

Moore RA, McQuay HJ: Prevalence of opioid adverse events in chronic non-malignant pain: Systematic review of randomized trials of oral opioids. Arthritis Res Ther. 2005; 7(5): R1046-R1051.

Kalso E, Edwards JE, Moore RA, et al.: Opioids in chronic non-cancer pain: Systematic review of efficacy and safety. Pain. 2004; 112(3): 372-380.

Eberhart LH, Morin AM, Wulf H, et al.: Patient preferences for immediate postoperative recovery. Br J Anaesth. 2002; 89(5): 760-761.

Smith HS, Laufer A: Opioid induced nausea and vomiting. Eur J Pharmacol. 2014; 722: 67-78.

Haiderali A, Menditto L, Good M, et al.: Impact on daily functioning and indirect/direct costs associated with chemotherapyinduced nausea and vomiting (CINV) in a U.S. Population. Support Care Cancer. 2011; 19(6): 843-851.

Ihbe-Heffinger A, Ehlken B, Bernard R, et al.: The impact of delayed chemotherapy-induced nausea and vomiting on patients, health resource utilization and costs in German cancer centers. Ann Oncol. 2004; 15(3): 526-536.

Shih YC, Xu Y, Elting LS: Costs of uncontrolled chemotherapy-induced nausea and vomiting among working-age cancer patients receiving highly or moderately emetogenic chemotherapy. Cancer. 2007; 110(3): 678-685.

Chan YC: Improving hospital cost accounting with activity-based costing. Health Care Manage Rev. 1993; 18(1): 71-77.

Apfel CC, Kranke P, Katz MH, et al.: Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: A randomized controlled trial of factorial design. Br J Anaesth. 2002; 88(5): 659-668.

Apfel CC: Pathophysiology, risk factors and assessment for nausea and vomiting in the postoperative phase. Anasthesiol Intensivmed Notfallmed Schmerzther. 2005; 40(8): 497-503.

Metter SE, Kitz DS, Young ML, et al.: Nausea and vomiting after outpatient laparoscopy: Incidence, impact on recovery room stay and cost. Anesth Analg. 1987; 66: S116.

Morris RW, Ernst E, Greaves DJ, et al.: An audit of the incidence and costs associated with postoperative nausea and vomiting (PONV) following major gynaecological surgery in an outpatient population. Br J Anaesth. 1993; 70(Suppl 1): A2.

Carroll NV, Miederhoff PA, Cox FM, et al.: Costs incurred by outpatient surgical centers in managing postoperative nausea and vomiting. J Clin Anesth. 1994; 6: 364-369.

Published

11/01/2014

How to Cite

Eberhart, MD, L., T. Koch, MSc, P. Kranke, MD, D. Rüsch, MD, A. Torossian, MD, and S. Nardi-Hiebl, MBA. “Activity-Based Cost Analysis of Opioid-Related Nausea and Vomiting Among Inpatients”. Journal of Opioid Management, vol. 10, no. 6, Nov. 2014, pp. 415-22, doi:10.5055/jom.2014.0238.