RESUMEN
INTRODUCTION: Intravenous (IV) iron is typically the preferred treatment for patients with iron deficiency anemia (IDA) who cannot tolerate or absorb oral iron, or who require fast replenishment of iron stores pre-operatively. Several IV iron formulations are available with different dosing characteristics affecting infusion speed and maximum dose. The aim was to develop a resource impact model to calculate the cost of establishing an IV iron clinic and model resource impact of different IV irons to inform clinicians and service providers implementing innovative pre-operative IV iron services in Ireland. METHODS: A resource impact tool was developed to model resource utilization and IDA treatment costs. Two fast-administration, high-dose formulations of IV iron are available in Ireland: iron isomaltoside 1000/ferric derisomaltose (IIM) and ferric carboxymaltose (FCM). The tool modeled clinic throughput based on their different dosing characteristics in a specific IDA population, capturing fixed overheads, variable costs, clinic income from private and publicly-funded patients, and savings associated with IV iron. RESULTS: Based on a 70:30 split between public and private patients in a new pre-operative service with capacity for 12 infusion slots weekly, IIM would facilitate correction of iron deficits in 474 patients annually, resulting in a net annual clinic balance of 42,736 on income of 159,887 and net costs of 117,151. FCM would facilitate treatment of 353 patients, resulting in a net annual clinic balance of 36,327 on income of 116,050 and costs of 79,722, a difference of 6408 and 121 patients treated in favor of using IIM over FCM. CONCLUSION: Based on this provider-perspective analysis, IIM would maximize clinic throughput relative to other IV iron formulations, allowing clinicians in Ireland to optimize their current service provision and expenditure, and model the impact of introducing IV iron clinics for pre-operative patients with IDA.
Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Anemia Ferropénica/tratamiento farmacológico , Disacáridos/uso terapéutico , Compuestos Férricos/uso terapéutico , Maltosa/análogos & derivados , Cuidados Preoperatorios/métodos , Administración Intravenosa , Instituciones de Atención Ambulatoria/economía , Costos y Análisis de Costo , Disacáridos/administración & dosificación , Disacáridos/economía , Compuestos Férricos/administración & dosificación , Compuestos Férricos/economía , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Humanos , Irlanda , Maltosa/economía , Maltosa/uso terapéutico , Modelos Económicos , Cuidados Preoperatorios/economíaRESUMEN
BACKGROUND: Local infiltration analgesia (LIA) is an effective pain management technique following total knee arthroplasty (TKA). OBJECTIVE: To investigate if LIA provides better analgesia for patients undergoing unilateral TKA than intrathecal morphine. DESIGN: Randomised controlled trial. SETTING: Single tertiary referral centre. PATIENTS: Consecutive American Society of Anesthesiologists Physical Status I to III patients scheduled to undergo unilateral TKA were randomised to two groups. INTERVENTION: The control group received spinal anaesthesia with intrathecal bupivacaine and preservative-free morphine 0.3âmg. The intervention group received opioid-free spinal anaesthesia with bupivacaine, followed by intra-operative infiltration of the knee with levobupivacaine 2âmgâkg and adrenaline 0.5âmg diluted to a volume of 100âml with 0.9% saline. An intra-articular catheter was placed during surgery and used to give a bolus of 15âml of levobupivacaine 0.5% on the morning of the first postoperative day. MAIN OUTCOME MEASURES: Visual analogue scale (VAS) scores for pain were assessed repeatedly for 48âh postoperatively, at rest and on passive knee flexion to 30°. The primary outcome was VAS scores for pain at rest and on movement at 24 postoperative hours. Secondary outcomes were VAS scores at rest and on movement at 2, 6, 12 and 48 postoperative hours, opioid consumption, degree of active flexion of operative knee achieved in the first 48âh and the incidence of opioid-related side effects. RESULTS: Forty three patients completed the study. Mean (± SD) VAS scores for pain at 24âh were lower in the intervention group than the control group at rest; 16.43 (± 20.3) vs. 37.2 (± 33.6), (Pâ=â0.029). VAS scores for pain at 24âh on movement were also lower in the intervention group vs. the control group; 39.1 (± 22.8) vs. 57.0 (± 30.9), (Pâ=â0.037). VAS scores were also lower on movement; 25.9 (± 16.8) vs. 40.5 (± 24.0), (Pâ=â0.028) at 48âh. CONCLUSION: We conclude that LIA conferred superior analgesia compared with intrathecal morphine 0.3âmg at 24 and 48âh following TKA. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01312415.