Can a simple institutionalised approach to cancer pain assessment and management in cancer centres improve pain outcomes and save money?


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Marie Fallon1,Peter Hall1,Katharina Dienberger1
1University of Edinburgh

Abstract

Background

Cancer pain in poorly controlled in more than 50% of hospital and cancer centre admissions. We developed a strategy to overcome individual clinician variability in assessment and management(The Edinburgh Pain Assessment and management Tool (EPAT).The EPAT study (Fallon M et l. JCO 2018; 36(13): 1284-1290) compared the effect of adding a bedside pain assessment and management tool (EPAT) to usual care (UC), with that of UC alone, on pain outcomes. In this two-arm parallel group cluster randomised (1:1) trial in 19 UK cancer centres, a simple systematic integrated approach improved pain outcomes for cancer centre inpatients without increasing opioid side effects.

Aim: To provide the cost analysis associated with the EPAT study. These data have not been presented elsewhere, nor published.

Method

Data analysis was performed using the free and open-source programming language R. To stay in line with the study design, costing data were truncated at day 7.The cost analysis consists of the cost per patient in the control group and in the intervention group. Costs calculated were: length of stay in hospital (LOS); medication costs; non drug costs eg spinal analgesia and palliative radiotherapy. Costs were identified using mainly Personal Social Services Research Unit (PSSRU) costs: medication costs were generated from the British National Formulary(BNF).

Results

At the start of the intervention phase of the study, 453 patients were in the control and 487 patients in the intervention group. The table shows costs results for LOS, pharmacological and non- pharmacological interventions.

Compared to the control group, the EPAT interventional group had a shorter LOS, with no increase in opioid prescriptions but more adjuvant drug prescriptions, along with more tailored pain and non-drug treatments. LOS was the largest driver of costs.

Table: Average per patient costs for the Length of stay (LOS), Medication and Non medication treatments

COSTS

Average Cost Control Arm

Average Cost Intervention Arm

LOS

£4193.71

£3865.74

Medication

£40.30

£35.88

Non medication treatments

£89.87

£116.75

Total

£4323.87

£4018.38

Conclusion

An institutional approach to standardise cancer pain assessment and management using EPAT gave better clinical outcomes, more tailored/personalised care and a cost saving(£305 per patient per admission).