David W Herd1, Clinton Newbury, Paul M Brown. 1. Children's Emergency Department, Starship Children's Hospital, Park Road, Auckland 1023, New Zealand. david.herd@mac.com
Abstract
INTRODUCTION:Starship Hospital Children's Emergency Department (CED) uses EMLA for topical anaesthesia during insertion of intravenous cannula (IVC). Amethocaine has recently been shown to offer more effective pain relief and work faster than EMLA, but may be more expensive. AIM: To determine cost implications of introducing topical amethocaine into CED practice. METHODS: Data were obtained from a randomised controlled trial, quality assurance project and an audit of topical anaesthetic use, with economic evaluation performed from the District Health Board perspective in 2007 NZ dollars and Euros. Proportion of children receiving topical anaesthetic cream during insertion of IVC was the primary benefit measure, and cost per child presenting to the department was the primary cost measure. A decision tree model was developed as a baseline, and sensitivity analysis was conducted. Multiple clinical scenarios were modelled, and incremental cost effectiveness ratios calculated compared to the baseline model. RESULTS: Scenarios modelled include providing no topical anaesthesia, using amethocaine exclusively or using a mixture of amethocaine and EMLA. All models are sensitive to the amount of cream applied at triage. The most cost effective model provided EMLA at triage to those most likely to need IVC; then amethocaine to other children later thought to require IVC. This model would cost NZ$1.05 per child, down from NZ$1.47. Proportion of children receiving cream during insertion of IVC would increase from 51% to 64%. The recommended model dominated the current situation. CONCLUSION: Use of amethocaine in a mixed model in the CED could reduce cost and increase the proportion of children receiving topical anaesthetic during insertion of IVC. Trial registration number Australian New Zealand Clinical Trials Register ACTRN12606000409572.
RCT Entities:
INTRODUCTION: Starship Hospital Children's Emergency Department (CED) uses EMLA for topical anaesthesia during insertion of intravenous cannula (IVC). Amethocaine has recently been shown to offer more effective pain relief and work faster than EMLA, but may be more expensive. AIM: To determine cost implications of introducing topical amethocaine into CED practice. METHODS: Data were obtained from a randomised controlled trial, quality assurance project and an audit of topical anaesthetic use, with economic evaluation performed from the District Health Board perspective in 2007 NZ dollars and Euros. Proportion of children receiving topical anaesthetic cream during insertion of IVC was the primary benefit measure, and cost per child presenting to the department was the primary cost measure. A decision tree model was developed as a baseline, and sensitivity analysis was conducted. Multiple clinical scenarios were modelled, and incremental cost effectiveness ratios calculated compared to the baseline model. RESULTS: Scenarios modelled include providing no topical anaesthesia, using amethocaine exclusively or using a mixture of amethocaine and EMLA. All models are sensitive to the amount of cream applied at triage. The most cost effective model provided EMLA at triage to those most likely to need IVC; then amethocaine to other children later thought to require IVC. This model would cost NZ$1.05 per child, down from NZ$1.47. Proportion of children receiving cream during insertion of IVC would increase from 51% to 64%. The recommended model dominated the current situation. CONCLUSION: Use of amethocaine in a mixed model in the CED could reduce cost and increase the proportion of children receiving topical anaesthetic during insertion of IVC. Trial registration number Australian New Zealand Clinical Trials Register ACTRN12606000409572.