OBJECTIVES: When selecting postoperative pain management (POPM) for an individual patient, clinicians weigh the analgesic efficacy, risk of adverse events, and any additional resource consumption associated with the administration of treatment. This analysis estimated the total cost and resource use associated with utilizing fentanyl iontophoretic transdermal system (ITS) versus standard intravenous patient-controlled analgesia (IV PCA) morphine for POPM.

METHODS: A cost calculation model was developed to evaluate the economic value of fentanyl ITS compared to IV PCA morphine for a hospital performing inpatient orthopedic surgery. The model considered resource use and direct costs for opioid related adverse events (ORAEs), IV PCA medication/device errors, supplies, equipment, hospital staff time and drug for the management of postoperative pain. Model assumptions were informed by published literature, the PREMIER hospital database, fentanyl ITS active-controlled trial data, and online sources.

RESULTS: The orthopedic patient population included knee arthroplasty (Clinical Classification Software CCS=152), total or partial hip replacement (CCS=153) laminectomy with excision intervertebral disc (CCS=3), or spinal fusion (CCS=158). The duration of pain management modeled was 48 hours. Fentanyl ITS use reduced the per-patient costs associated with ORAEs by $402, IV PCA medication/device errors by $29, and the direct costs of supplies and equipment by $98. Fentanyl ITS reduced RN/LPN time associated with PCA administration tasks by 38% and eliminated tasks performed by the pharmacy, central supply and bioengineering staff for a savings of $35. CONCLUSIONS: Within the hospital setting, this analysis calculates fentanyl ITS may reduce the economic burden associated with ORAEs, pump and programming errors, labor and supply/equipment costs compared to IV PCA, resulting in a potential economic benefit of $579 per patient over a 48-hour period.