OBJECTIVES : Local infiltration analgesia(LIA), epidural analgesia(EA) and nerve block analgesia(NBA) are frequently used postoperative pain management modalities after total knee arthroplasty. The aim of this study was to conduct a cost-effectiveness analysis comparing the use of LIA, EA, and NBA in the first 72h postoperatively in patients undergoing total knee arthroplasty.

METHODS : A decision analytic model compared three strategies: LIA, EA versus NBA in patients undergoing total knee arthroplasty for postoperative pain management. Patient-reported pain scores sourced from published meta-analyses measured treatment effectiveness. Costing was derived from the Medicare fee schedule, publicly available hospital charge masters and public articles. Charges were converted to costs and adjusted for 2019 US dollars. A patient payer perspective was adopted. Incremental cost-effectiveness ratios (ICERs) were evaluated against WTP thresholds of $500 and $1,000 for postoperative pain control. Robustness of the model was addressed in one-way analyses and probabilistic sensitivity analysis.

RESULTS : The pain score in the first 72h postoperatively was 2.27, 2.67, 3.22 in LIA,EA,and NBA group,and their cost was $1095.0106, $1131.4879 and $1241.121,respectively.LIA for postoperative analgesia in total knee arthroplasty is costing saving .The sensitivity analysis showed that the model we built was robustness.

CONCLUSIONS : LIA for postoperative analgesia in total knee arthroplasty is costing saving . LIA for postoperative analgesia in total knee arthroplasty is costing saving . The cost effectiveness analysis suggests that LIA is the dominant treatment strategy for managing postoperative pain (i.e. more effective and less costly). This economic evaluation may be useful for clinicians to design analgesic regimen for pain management after total knee arthroplasty