Patient-Controlled Intravenous Morphine Analgesia Combined with Transcranial Direct Current Stimulation for Post-Thoracotomy Pain: A Cost-Effectiveness Study and A Feasibility For Its Future Implementation

• Published in: International journal of environmental research and public health Vol. 17; no. 3; p. 816
• Main Authors: Rancic, Nemanja, Mladenovic, Katarina, Ilic, Nela V, Dragojevic-Simic, Viktorija, Karanikolas, Menelaos, Ilic, Tihomir V, Stamenkovic, Dusica M
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI 28-01-2020
• Subjects: cost and cost analysis; pharmacoeconomics; acute pain; transcranial direct current stimulation; morphine; pain, postoperative
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph17030816

This prospective randomized study aims to evaluate the feasibility and cost-effectiveness of combining transcranial direct current stimulation (tDCS) with patient controlled intravenous morphine analgesia (PCA-IV) as part of multimodal analgesia after thoracotomy. Patients assigned to the active treatment group (a-tDCS,
= 27) received tDCS over the left primary motor cortex for five days, whereas patients assigned to the control group (sham-tDCS,
= 28) received sham tDCS stimulations. All patients received postoperative PCA-IV morphine. For cost-effectiveness analysis we used data about total amount of PCA-IV morphine and maximum visual analog pain scale with cough (VASP-C
). Direct costs of hospitalization were assumed as equal for both groups. Cost-effectiveness analysis was performed with the incremental cost-effectiveness ratio (ICER), expressed as the incremental cost (RSD or US$) per incremental gain in mm of VASP-C
reduction. Calculated ICER was 510.87 RSD per VASP-C
1 mm reduction. Conversion on USA market (USA data 1.325 US$ for 1 mg of morphine) revealed ICER of 189.08 US$ or 18960.39 RSD/1 VASP-C
1 mm reduction. Cost-effectiveness expressed through ICER showed significant reduction of PCA-IV morphine costs in the tDCS group. Further investigation of tDCS benefits with regards to reduction of postoperative pain treatment costs should also include the long-term benefits of reduced morphine use.