OBJECTIVES:

The primary outcome of this study was to compare the budget impact of intravenous acetaminophen (IV APAP) in combination with opioids versus opioids alone as a pain management strategy after neonatal esophageal atresia (EA) and tracheoesophageal fistula (TEF) repair.

METHODS:

A decision-analytic model was designed to compare the outcomes of EA/TEF repair in a theoretical cohort of 974 neonates. IV APAP with opioids as post-operative pain management in the treatment group was compared with the use of opioids alone in the control group. Model inputs were derived from the literature and the Pediatric Health Information System. Base-case and sensitivity analyses were performed.

RESULTS:

The use of IV APAP in the treatment group resulted in an increased total cost of $230,977 per patient compared to the control group. The treatment group had an increased length-of-stay and number of days receiving total parenteral nutrition, averaging 82.3 and 64.3 days, respectively, compared to 59.8 and 31.8 days in the control group. The addition of IV APAP was associated with a decreased mortality rate of 4.5% compared to 20.7% in the controls.

CONCLUSIONS:

The use of IV APAP alongside opioids in EA/TEF repair increases costs, use of total parental nutrition, and length-of-stay. Despite its association with an increase in healthcare utilization, our findings suggest IV APAP provides a mortality benefit to neonates.