Analgesia for Labor Pain: A Cost Model

ALEX MACARIO, W. CRAIG SCIBETTA, JOHN NAVARRO AND ED RILEY

Department of Anesthesia and Health Research and Policy, Stanford University, Stanford, California

Anesthesiology, 92: 841-850, 2000

Epidural analgesia is thought to be more costly to deliver and to have a greater incidence of complications than IV analgesia, yet no published study has provided a precise cost analysis of epidural vs IV analgesia for the relief of labor pain, and it is unknown how much more costly per patient it is for society to offer epidural analgesia. A cost-identification model was developed to analyze the comparative costs of epidural and IV analgesia for healthy parturients during labor.

A computerized search of the literature was conducted to identify and estimate the incidence of all complications related to each analgesic technique. Analysis of data from the study institution's cost-accounting system provided the hospital cost for patients admitted for delivery and estimates of the cost of each complication. A sensitivity analysis was performed to evaluate the cost impact of changing key variables, including maternal and fetal complications and the need for cesarean section. In a secondary analysis, the cost of nursing was assumed to be fixed.

When the cesarean section rate is assumed to be 20% for both IV and epidural analgesia, the additional cost of anesthesia professional services for epidural over IV analgesia is $218. Assuming that nursing costs increase as interventions increase, the additional expected cost per patient to society of epidural analgesia for relief of pain is $338 more than that for IV analgesia. If nursing costs remain stable despite additional interventions related to pain management, then the additional cost of epidural analgesia is reduced from $338 to $259.

Women who receive epidural analgesia during labor are found to have lower pain scores during the first and second stages of labor and report higher satisfaction with pain management than women receiving IV analgesia. Improved pain relief may lower the incidence of posttraumatic stress disorder, result in a higher incidence of VBACS, and accelerate maternal recovery. The greater cost of epidural analgesia results from increased professional fees and complication costs. It is important, however, to weigh the value of better pain relief against increased costs.